Abstract
The health policy New Directions committed the British Columbia government to a population health perspective and extensive community involvement in the health services reform process. The policy envisaged elected citizen boards with authority to raise revenues and exercise a significant degree of local autonomy. Academic and public attention has been paid to the decision in November 1996 to collapse New Directions’ two-tier governance structure into a single level. Less attention has been paid to the profound changes that occurred prior to the government’s reversal on the question of governance. This paper focusses on those changes. During the critical three years between the 1993 launch of the reform and its formal revision in 1996, the government’s positions on elections, taxation power, local autonomy and scope of action for regional boards all changed. Those changes marked a retreat from political accountability to the community and an advance towards managerial accountability to the government.
Abrégé
La politique de santé « New Directions » avait engagé le gouvernement de la Colombie-Britannique dans une perspective de santé de la population et de participation intensive de la communauté au processus de réforme des services de santé. La politique prévoyait l’élection de conseils de citoyens dotés des pouvoirs de générer des revenus et d’exercer un niveau significatif d’autonomie locale. L’attention académique et publique a été attirée, en novembre 1996, sur le fait que la structure d’autorité prévue dans « New Directions » avait été réduite de deux niveaux à un seul. Moins d’intérêt a été porté aux changements profonds qui se sont produits avant que le gouvernement ne révise la structure décisionnelle. Cet article se concentre sur ces changements. Pendant les trois années critiques entre le lancement de la réforme en 1993 et sa révision formelle en 1996, le gouvernement a changé sa position au sujet des élections du pouvoir d’imposition, de l’autonomie locale et de la portée des actions des comités régionaux. Ces changements ont marqué un recul au plan de la responsabilisation politique vis à vis de la communauté et un progrès de la responsabilisation de l’administration vis à vis du gouvernement.
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References
Ministry of Health. New Directions for a Healthy British Columbia, 2–93, Victoria: Ministry of Health and Ministry Responsible for Seniors, 1993.
Report of the Royal Commission on Health Care and Costs (Seaton Commission). Two volumes plus summary report. Victoria: Government of British Columbia, 1991.
Majone G. Evidence, Argument and Persuasion in the Policy Process. New Haven: Yale University Press, 1989.
Stone DA. Policy Paradox and Political Reason. New York: Harper Collins, 1988.
Hurley J, Lomas J, Bhatia V. When tinkering is not enough: Political reform to manage health care resources. Can Public Admin 1995;37(3):490–514.
Klein R. The Anatomy of Accountability. Proceedings CHEPA 6th Annual Policy Conference. Hamilton: McMaster University, 1993.
Rhodes RAW. Beyond Westminster and Whitehall: The Sub-governments of Britain. London: Allen and Unwin, 1988.
Day P, Klein R. Accountabilities: Five Public Services. London: Tavistock, 1987.
Light DW. The rhetorics and realities of community health care: The limits of countervailing power to meet the needs of the twenty-first century. J Health Politics, Policy and Law 1997;23(1):104–45.
Ministry of Health. Community Health Council and Regional Health Board Proposed Operating Principles. Victoria: Ministry of Health and Ministry Responsible for Seniors, 1994.
Morfitt G. Report of the Auditor General on Regionalization, Accountability and Governance. Victoria: Auditor General’s Office, 1998.
McLintock B. Health jobs filled on political whim. The Province 1998 March 25; Sect.A:39.
Carver J. Boards that Make a Difference. San Francisco: Jossey-Bass, 1990.
Harrison J, Nutley S. Professions and management in the public sector: The experience of local government and the NHS in Britain, In: Leopold J, et al. (Eds.), The National Health Service and the Limits of Management. Aldershot: Avebury, 1996.
Mills A. Decentralization and Accountability from an International Perspective: What are the choices? Proceedings CHEPA 6th annual conference. Hamilton: McMaster University, 1993.
Saltman RB, von Otter C. Planned Markets and Public Competitive Strategies: Reform in Northern European Health Systems. Buckingham: Open University Press, 1992.
Ham C, Best G. Goodbye rubber stamp image. Health Service J 1990;99,5147:482–83.
Davidson A. Regional health board control and accountability: A British Columbia case study (in review), 1999.
Lomas J, Woods J, Veenstra G. Devolving authority for health care in Canada’s provinces. CMAJ 1997;156(3):371–77, 156(4):513-20, 156(5):669-76, 156(6):817-23.
Mills A, Vaughan JP, Smith DL, Tabibzadeh I. Health System Decentralization: Concepts, Issues and Country Experience. Geneva: World Health Organization, 1990.
Lamb J. New directions in health care pointing the wrong way. Vancouver Sun 1995 May 19; Sect. A:3.
Abelson J, et al. Does the community want devolved authority? Results of deliberative polling in Ontario. CMAJ 1995;153(4):403–12.
Union of BC Municipalities. Recommendations to the Regionalization Assessment Team on New Directions. Vancouver: Union of B.C. Municipalities, 1996.
Morone JA, Marmor T. Representing the consumer interests: The case of American health planning, In: Checkoway B (Ed.), Citizens and Health Care: Participation and Planning for Social Change. New York: Pergamon Press, 1981.
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Davidson, A.R. British Columbia’s Health Reform: “New Directions” and Accountability. Can J Public Health 90 (Suppl 1), S35–S38 (1999). https://doi.org/10.1007/BF03403577
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DOI: https://doi.org/10.1007/BF03403577