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1
-
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84982062182
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When tinkering is not enough: Provincial reform to manage health care resources
-
Fall
-
Lomas et al., "When tinkering is not enough: provincial reform to manage health care resources," CANADIAN PUBLIC ADMINISTRATION vol. 37, no. 3 (Fall 1994), p. 492.
-
(1994)
CANADIAN PUBLIC ADMINISTRATION
, vol.37
, Issue.3
, pp. 492
-
-
Lomas1
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2
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33846271203
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Government of Nova Scotia, Minister's Action Committee on Health System Reform, 11 April
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Government of Nova Scotia, Minister's Action Committee on Health System Reform, Background Paper on Regionalization, 11 April 1994, p. 5.
-
(1994)
Background Paper on Regionalization
, pp. 5
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-
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4
-
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0031856652
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Regionalization of health care services in Canada: A critical perspective
-
See, e.g
-
See, e.g., John Church and Paul Barker, "Regionalization of health care services in Canada: a critical perspective," International Journal of Health Services 28, no. 3, p. 468.
-
International Journal of Health Services
, vol.28
, Issue.3
, pp. 468
-
-
Church, J.1
Barker, P.2
-
5
-
-
0027753952
-
-
Ibid., 370. See also Charles and DeMaio, Lay participation in health care decision-making: a conceptual framework, Journal of Health Politics, Policy, and Law 18, no. 4 (Winter 1993), p. 881.
-
Ibid., 370. See also Charles and DeMaio, "Lay participation in health care decision-making: a conceptual framework," Journal of Health Politics, Policy, and Law 18, no. 4 (Winter 1993), p. 881.
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-
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6
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-
33846300801
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MSNS wants public to have a say in de-insuring plans
-
4 July
-
Donalee Moulton, "MSNS wants public to have a say in de-insuring plans," Medical Post, 4 July 1995, p. 32.
-
(1995)
Medical Post
, pp. 32
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-
Moulton, D.1
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7
-
-
0026614317
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Community participation in Quebec's health system: A strategy to curtail community empowerment?
-
See
-
See Michael O'Neill, "Community participation in Quebec's health system: a strategy to curtail community empowerment?" International Journal of Health Services 22, no. 2 (1992).
-
(1992)
International Journal of Health Services
, vol.22
, Issue.2
-
-
O'Neill, M.1
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8
-
-
33846270842
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NS resurrects provincial health council: MSNS says council should have more than one MD on it
-
27 October
-
Donalee Moulton, "NS resurrects provincial health council: MSNS says council should have more than one MD on it," Medical Post, 27 October 1998, p. 30.
-
(1998)
Medical Post
, pp. 30
-
-
Moulton, D.1
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10
-
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0000299486
-
Reforming health care governance: The case of Nova Scotia
-
See, Summer
-
See James Bickerton, "Reforming health care governance: the case of Nova Scotia," Journal of Canadian Studies 43, no. 2 (Summer 1999);
-
(1999)
Journal of Canadian Studies
, vol.43
, Issue.2
-
-
Bickerton, J.1
-
11
-
-
33846285856
-
Community care without the community
-
17 September
-
and Dan Currie, "Community care without the community," Halifax Chronicle Herald, 17 September 1996, p. B2.
-
(1996)
Halifax Chronicle Herald
-
-
Currie, D.1
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12
-
-
33846270843
-
-
See Hon. Jamie Muir, Ministerial Statement, Nova Scotia Legislative Assembly, 5 November 1999; see also Department of Health press release, 21 October 1999.
-
See Hon. Jamie Muir, Ministerial Statement, Nova Scotia Legislative Assembly, 5 November 1999; see also Department of Health press release, 21 October 1999.
-
-
-
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13
-
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33846324879
-
-
Due to confidentiality agreements, the identity of people on the DHA cannot be disclosed. There were, however, newspaper reports of health board members being fearful that the community element would be diminished under the DHA model. The chairman of a Cape Breton CHB said that it's becoming a very Department of Health-controlled series of policies. Allena MacDonald, CB Health Board chairmen disagree on restructuring, Halifax Chronicle Herald, 23 September 2000, p. A6.
-
Due to confidentiality agreements, the identity of people on the DHA cannot be disclosed. There were, however, newspaper reports of health board members being fearful that the community element would be diminished under the DHA model. The chairman of a Cape Breton CHB said that "it's becoming a very Department of Health-controlled series of policies." Allena MacDonald, "CB Health Board chairmen disagree on restructuring," Halifax Chronicle Herald, 23 September 2000, p. A6.
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-
-
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14
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33846282496
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An excellent discussion of this issue can be found in Nova Scotia Community Health Boards' Survey and CHB Consensus Conference: Results and Recommendation, Department of Health, 22 March 2000
-
An excellent discussion of this issue can be found in Nova Scotia Community Health Boards' Survey and CHB Consensus Conference: Results and Recommendation, Department of Health, 22 March 2000.
-
-
-
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15
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33846286994
-
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Government of Nova Scotia, Report of the Auditor General (1998), p. 132. It is interesting to note that the auditor general also attributed the deficits to deficiencies in the Department of Health and delays in planning approval for RHB business plans. When boards are not informed of funding decisions on a timely basis and told they must maintain services and cannot implement initiatives until approved, then the boards are effectively paralyzed.
-
Government of Nova Scotia, Report of the Auditor General (1998), p. 132. It is interesting to note that the auditor general also attributed the deficits to deficiencies in the Department of Health and delays in planning approval for RHB business plans. "When boards are not informed of funding decisions on a timely basis and told they must maintain services and cannot implement initiatives until approved, then the boards are effectively paralyzed."
-
-
-
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16
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33846304795
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Report blames Department communication breakdown,
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Halifax, 21 December
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Richard Dooley, "Report blames Department communication breakdown," Daily News, Halifax, 21 December 1998, p. 8.
-
(1998)
Daily News
, pp. 8
-
-
Dooley, R.1
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18
-
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33846304795
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Report blames department communication breakdown
-
See also, Halifax, 21 December
-
See also Richard Dooley, "Report blames department communication breakdown," in Daily News, Halifax, 21 December 1999, p. 8.
-
(1999)
Daily News
, pp. 8
-
-
Dooley, R.1
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19
-
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33846286253
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Health care regionalization update: NS moves to District Health Authorities
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23 November
-
Donalee Moulton, "Health care regionalization update: NS moves to District Health Authorities," Medical Post, 23 November 1999.
-
(1999)
Medical Post
-
-
Moulton, D.1
-
20
-
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33846280625
-
-
The same quotes also appeared in Kevin Carmichael, Conservatives considering outlawing hospital deficits, Canadian Press Newswire, 5 November 1999.
-
The same quotes also appeared in Kevin Carmichael, "Conservatives considering outlawing hospital deficits," Canadian Press Newswire, 5 November 1999.
-
-
-
-
21
-
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33846292677
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Muir, minister of health, presentation to the Commission of Health Care in Canada
-
17 April
-
Hon. J., Muir, minister of health, presentation to the Commission of Health Care in Canada, Government of Nova Scotia, 17 April 2002, pp. 4, 7, 10;
-
(2002)
Government of Nova Scotia
-
-
Hon, J.1
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22
-
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33846313338
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Nova Scotia is looking at new funding formula to dole out health care dollars
-
29 March
-
"Nova Scotia is looking at new funding formula to dole out health care dollars," Canadian Press Newswire, 29 March 2002;
-
(2002)
Canadian Press Newswire
-
-
-
24
-
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33846305535
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New legislation gives communities stronger voice," 29 March 2000; NS Department of Health, "Health authorities act proclaimed
-
Nova Scotia Department of Health press release, 29 January
-
Nova Scotia Department of Health press release, "New legislation gives communities stronger voice," 29 March 2000; NS Department of Health, "Health authorities act proclaimed," Transition News: Future Directions for the Health System Vol. 1(11), 29 January 2001;
-
(2001)
Transition News: Future Directions for the Health System
, vol.1
, Issue.11
-
-
-
25
-
-
33846308603
-
-
NS Department of Health, Annual Accountability Report for the Year 2000-2001, 20 December 2001, p. 4;
-
NS Department of Health, Annual Accountability Report for the Year 2000-2001, 20 December 2001, p. 4;
-
-
-
-
26
-
-
33846307210
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Nova Scotia will create nine district health authorities
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"Nova Scotia will create nine district health authorities," Community Action 15, no. 9 (1999), p. 7.
-
(1999)
Community Action
, vol.15
, Issue.9
, pp. 7
-
-
-
28
-
-
33846270479
-
Health bill aims for collective savings,
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30 March
-
and Cathy Nicoll, "Health bill aims for collective savings," Daily News, 30 March 2000, p. A4.
-
(2000)
Daily News
-
-
Nicoll, C.1
-
29
-
-
33846283949
-
Government assumes health care debt,
-
2 February
-
Shaune MacKinlay, "Government assumes health care debt," Daily News, 2 February 2001;
-
(2001)
Daily News
-
-
MacKinlay, S.1
-
30
-
-
33846269440
-
Nova Scotia attempts to shrink health care spending, again
-
27 February
-
Ann Graham, "Nova Scotia attempts to shrink health care spending, again," Medical Post, 27 February 2001, p. 35;
-
(2001)
Medical Post
, pp. 35
-
-
Graham, A.1
-
31
-
-
33846284294
-
Health care cuts to be deep, grits say
-
1 July, Al
-
and Clare Mellor and David Jackson, "Health care cuts to be deep, grits say," Halifax Chronicle Herald, 1 July 2000, Al.
-
(2000)
Halifax Chronicle Herald
-
-
Mellor, C.1
Jackson, D.2
-
32
-
-
33846313339
-
-
Kevin Adshade, Further hospital cuts? New Glasgow Evening News, 11 November 2001, p. Al. Harry Inder, Projected deficits,
-
Kevin Adshade, "Further hospital cuts?" New Glasgow Evening News, 11 November 2001, p. Al. Harry Inder, "Projected deficits,"
-
-
-
-
34
-
-
33846266358
-
-
Capital District Health Authority, 8 March
-
Capital District Health Authority, Capital Health Budget Fact Sheet 2002/2003,8 March 2002.
-
(2002)
Capital Health Budget Fact Sheet
, vol.2002-2003
-
-
-
35
-
-
33846318683
-
-
Presentation to the Law Amendments Committee on behalf of CHBS in Central Region, 14 April
-
Presentation to the Law Amendments Committee on behalf of CHBS in Central Region, 14 April 2000.
-
(2000)
-
-
-
36
-
-
33846282832
-
-
Canadian Medical, Association, The Language of Health System Reform: Report of the Working Group on Regionalization and Decentralization (Ottawa, 1993).
-
Canadian Medical, Association, The Language of Health System Reform: Report of the Working Group on Regionalization and Decentralization (Ottawa, 1993).
-
-
-
-
37
-
-
33846283198
-
-
Dr. Jim Smith, The Tory health care plan, Nova Scotia Liberal Caucus, available online at www.liberalcaucus-ns.com/oped/200000107. html. It was very difficult to obtain an exact number with respect to the cost of transition. According to numbers obtained through a Freedom of Information request, the Department of Health only incurred $1.5 million in transition costs. But the same request revealed that in order to obtain costs incurred by each individual DHA, separate requests would have to be made to each one directly. According to the 2001 business plan from the DHA 3 (The Valley), it cost $400,000 to change from a board to an authority.
-
Dr. Jim Smith, "The Tory health care plan," Nova Scotia Liberal Caucus, available online at www.liberalcaucus-ns.com/oped/200000107. html. It was very difficult to obtain an exact number with respect to the cost of transition. According to numbers obtained through a Freedom of Information request, the Department of Health only incurred $1.5 million in transition costs. But the same request revealed that in order to obtain costs incurred by each individual DHA, separate requests would have to be made to each one directly. According to the 2001 business plan from the DHA 3 (The Valley), it cost $400,000 to change from a board to an authority.
-
-
-
-
38
-
-
33846326382
-
-
See Annapolis Valley District Health Authority Business Plan
-
See Annapolis Valley District Health Authority Business Plan, 2001.
-
(2001)
-
-
-
39
-
-
33846291173
-
-
Nova Scotia Legislative Assembly, Hansard for the 58th General Assembly, 7 April 2000, p. 3527.
-
Nova Scotia Legislative Assembly, Hansard for the 58th General Assembly, 7 April 2000, p. 3527.
-
-
-
-
40
-
-
33846282833
-
Health care cuts: Veil of secrecy must be lifted
-
5 April
-
Jim Smith, "Health care cuts: veil of secrecy must be lifted," Liberal Caucus of Nova Scotia, 5 April 2000.
-
(2000)
Liberal Caucus of Nova Scotia
-
-
Smith, J.1
-
41
-
-
33846270121
-
-
Dr. Smith made similar comments during debate in the Nova Scotia Legislature; see, 5 November
-
Dr. Smith made similar comments during debate in the Nova Scotia Legislature; see Hansard, 5 November 1999.
-
(1999)
-
-
Hansard1
-
43
-
-
33846317923
-
Liberals claim Conservatives overpaying health executives,
-
2 May
-
"Liberals claim Conservatives overpaying health executives," Daily News, 2 May 2001, p. 7.
-
(2001)
Daily News
, pp. 7
-
-
-
45
-
-
33846270480
-
-
Government of Nova Scotia, The Minister's Task Force on Regionalized Health Care in Nova Scotia (1999). See especially p. 42, Stakeholder input on regionalized health care in Nova Scotia: Physicians.
-
Government of Nova Scotia, The Minister's Task Force on Regionalized Health Care in Nova Scotia (1999). See especially p. 42, "Stakeholder input on regionalized health care in Nova Scotia: Physicians."
-
-
-
-
46
-
-
33846314875
-
-
Ibid.
-
-
-
-
47
-
-
33846268912
-
-
When each of the provinces embarked upon regionalization at different times, physicians from all provinces implementing a regional system vehemently opposed the restructuring. They denounced the actions of their respective governments and urged elected members to reconsider this policy stance. The British Columbia Medical Association, for example, issued a report on behalf of its members that stated that regionalization remains an intangible concept with which no one is comfortable (Medical Post, 1 November 1994, p. 2, and 23 September 1997, p. 36).
-
When each of the provinces embarked upon regionalization at different times, physicians from all provinces implementing a regional system vehemently opposed the restructuring. They denounced the actions of their respective governments and urged elected members to reconsider this policy stance. The British Columbia Medical Association, for example, issued a report on behalf of its members that stated that regionalization "remains an intangible concept with which no one is comfortable" (Medical Post, 1 November 1994, p. 2, and 23 September 1997, p. 36).
-
-
-
-
48
-
-
33846325628
-
-
In Alberta, doctors even threatened to leave the province because of the outcomes of regionalization Western Report, 13 February 1995, pp. 6-8, While the exact power of the physician lobby in Nova Scotia has never been clearly documented, it is instructive to note that in Nova Scotia, a consistent have-not province, doctors are the fourth highest paid in the country
-
In Alberta, doctors even threatened to leave the province because of the outcomes of regionalization (Western Report, 13 February 1995, pp. 6-8). While the exact power of the physician lobby in Nova Scotia has never been clearly documented, it is instructive to note that in Nova Scotia, a consistent "have-not" province, doctors are the fourth highest paid in the country.
-
-
-
-
49
-
-
33846318682
-
Does regionalization work? Answers to the questions depend on who you ask and where you ask it
-
13 January
-
Joe McAllister, "Does regionalization work? Answers to the questions depend on who you ask and where you ask it," Medical Post, 13 January 1998.
-
(1998)
Medical Post
-
-
McAllister, J.1
-
50
-
-
33846327372
-
Regionalized care to undergo review
-
17 November
-
Donalee Moulton, "Regionalized care to undergo review," Medical Post, 17 November 1998, p. 44.
-
(1998)
Medical Post
, pp. 44
-
-
Moulton, D.1
-
51
-
-
33846291172
-
In Nova Scotia regionalization is failing medical society
-
4 November
-
Donalee Moulton, "In Nova Scotia regionalization is failing medical society," Medical Post, 4 November 1997, p. 1;
-
(1997)
Medical Post
, pp. 1
-
-
Moulton, D.1
-
52
-
-
33846278120
-
Nova Scotia regional health system deeply flawed, needs change: Improvements slow coming past, MSNS president says
-
5 June
-
Donalee Moulton, "Nova Scotia regional health system deeply flawed, needs change: improvements slow coming past, MSNS president says," ibid., 5 June 1998, p. 54.
-
(1998)
Medical Post
, pp. 54
-
-
Moulton, D.1
-
53
-
-
33846312981
-
NS doctors prepare to fight regionalization
-
See also, 1 July
-
See also. Matt Borsellino, "NS doctors prepare to fight regionalization," ibid., 1 July 1997, p. 12;
-
(1997)
Medical Post
, pp. 12
-
-
Borsellino, M.1
-
54
-
-
33846311173
-
Nova Scotia Conservatives holding firm on dismantling regional health promise
-
28 September
-
and Donalee Moulton, " Nova Scotia Conservatives holding firm on dismantling regional health promise," ibid., 28 September, 1999, p. 6.
-
(1999)
Medical Post
, pp. 6
-
-
Moulton, D.1
-
55
-
-
33644912459
-
Changing Party Politics in Atlantic Canada
-
For an account of Nova Scotia's political culture, see, Hugh G. Thorburn and Alan Whitehorn, eds, Toronto: Prentice Hall
-
For an account of Nova Scotia's political culture, see Agar Adamson and Ian Stewart, "Changing Party Politics in Atlantic Canada," in Hugh G. Thorburn and Alan Whitehorn, eds., Party Politics in Canada (Toronto: Prentice Hall, 2001), pp. 302-20.
-
(2001)
Party Politics in Canada
, pp. 302-320
-
-
Adamson, A.1
Stewart, I.2
-
56
-
-
33846286599
-
-
It is important not to overstate how effective a local, democratically elected board can be. In Alberta prior to the regionalization reforms, for example, many small jurisdictions had elected boards for local hospitals and yet, as one interviewee declared, between the Department of Health, and the doctors, and the unions, and the administrators, the only power the board had was to decide if the broom handles were red, green, or blue. The major reason the board existed was to be a lightening rod for anything that went wrong.
-
It is important not to overstate how effective a local, democratically elected board can be. In Alberta prior to the regionalization reforms, for example, many small jurisdictions had elected boards for local hospitals and yet, as one interviewee declared, "between the Department of Health, and the doctors, and the unions, and the administrators, the only power the board had was to decide if the broom handles were red, green, or blue. The major reason the board existed was to be a lightening rod for anything that went wrong."
-
-
-
-
57
-
-
33846302170
-
-
Andre Picard, for example, writes that regionalization has been highly successful in Alberta: By integrating a broad range of services - hospitals, public health, home care, long-term care and community health - under a single administration, regional health authorities can make more rational spending decisions. They are also more efficient and responsive, to both patients and staff. (Every province has since introduced a form of regionalization ... But none have done it as thoroughly as Alberta). Alberta's bigger bang for health-care bucks, Globe and Mail, 28 October 2004, p. A5.
-
Andre Picard, for example, writes that regionalization has been highly successful in Alberta: "By integrating a broad range of services - hospitals, public health, home care, long-term care and community health - under a single administration, regional health authorities can make more rational spending decisions. They are also more efficient and responsive, to both patients and staff. (Every province has since introduced a form of regionalization ... But none have done it as thoroughly as Alberta)." "Alberta's bigger bang for health-care bucks," Globe and Mail, 28 October 2004, p. A5.
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-
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