Health reform in Alberta: The introduction of health regions

Canadian Public Administration

Volumn 51, Issue 2, 2008, Pages 217-238

  Church, John ^a   Smith, Neale ^b  

^a UNIVERSITY OF ALBERTA   (Canada)

^b UNIVERSITY OF BRITISH COLUMBIA   (Canada)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 51349143636     PISSN: 00084840     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1754-7121.2008.00016.x     Document Type: Article

References (69)

1. P.A. Hall, "Policy paradigms, social learning, and the state: The case of economic policymaking in Britain," Comparative Politics 25, no. 3 (Spring 1993), pp. 275-96. For purposes of this analysis, "ideas" refers to underlying values and information contributing to policy choices. "Interests" refers to the various actors - interest groups, politicians, bureaucrats and policy entrepreneurs - who influence policy choices and their motivations. "Institutions" refers to the formal and informal structures and processes involved in public policy decision-making.
2. John N. Lavis, Suzanne E. Ross and Jeremiah E. Hurley et al., Examining the role of health-services research in public policymaking," Milbank Quarterly 80, no. 1 (2002), pp. 125-54.
3. Hubert L. Laframboise, "Outflanking dominant elites," Policy Options 7, no. 6 (July/August 1986), pp. 36-41.
4. More recent analysis on emerging health-care reform in Ontario continues to echo this assessment. On this see, W. Michael Fenn, "Reinvigorating publicly funded medicare in Ontario: New public policy and administration techniques," CANADIAN PUBLIC ADMINISTRATION 49, no. 4 (Winter 2006), p. 545.
5. Geoffrey R. Weller, "From 'pressure group politics' to 'medical-industrial complex': The development of approaches to the politics of health," Journal of Health Politics, Policy and Law 1, no. 4 (1977), pp. 444-60.
6. Robert R. Alford, Health Care Politics: Ideological and Interest Group Barriers to Reform (Chicago: University of Chicago Press, 1975).
7. John Church and Paul Barker, "Regionalization of health services in Canada: A critical perspective," International Journal of Health Services 28, no. 3 (1998), pp. 467-86.
8. Allan Tupper, Larry Pratt and Ian Urquhart "The Role of Government," in Allan. Tupper and R. Gibbins, eds., Government and Politics in Albert (Edmonton: University of Alberta Press, 1992), pp. 49-50. Having said this, health received a thirty-four-per-cent increase between 1981 and 1989. Other departments such as Environment and Transportation and Utilities experienced major cuts during the same time period - ninety-two per cent and seventy-seven per cent, respectively.
9. Rand Dyck, Provincial Politics in Canada: Towards the Turn of the Century, 3rd ed. (Scarborough, Ont.: Prentice-Hall Canada, 1996), pp. 21-2. In the 1986 election, the opposition won twenty-two of eighty-three seats. In 1989, opposition support increased by two seats, with government electoral support dropping from fifty-one to forty-four per cent of the popular vote. In 1993, opposition seats increased by eight, with thirty-two Liberals forming the Official Opposition. AU of the new opposition seats were either in Calgary or Edmonton.
10. Alberta, Department of Health, A New Vision for Long Term Care - Meeting the Need (the Mirosh Report) (Edmonton: Queen's Printer, 1988).
11. Donald J. Philippon and Sheila A. Wasylyshyn, "Health-care reform in Alberta," CANADIAN PUBLIC ADMINISTRATION 39, no. 1 (Spring 1996), p. 73.
12. Alberta, Ministry of Hospital and Medical Care, Advisory Committee on the Utilization of Medical Services (Watanabe Committee), Report (Edmonton: Queen's Printer, 1989).
13. Hyndman had been one of the other five original Progressive Conservatives to enter the provincial legislature with Peter Lougheed in 1967. The overlap in membership between the two committees was significant.
14. Alberta, Premier's Commission on Future Health Care for Albertans, The Rainbow Report: Our Vision for Health, Volume 1 (Edmonton: Queen's Printer, 1989), pp. 11-15. The commission received more than 1,600 written or telephone comments from public hearings held with 68 province-wide organizations, 349 groups and associations, and 1,230 individuals.
15. Ibid., p. 119.
16. Ibid., p. 107 (emphasis in the original).
17. Alberta, Department of Health, Partners in Health: The Government of Alberta's Official Response to the Premier's Commission on Future Health Care for Albertans (Edmonton: Queen's Printer, 1991), p. 39.
18. Alberta, Ministry of Health, Health Vision: Turning Ideas into Reality. Volume 1, Issue 2 (Edmonton: Queen's Printer, 1992), pp. 2-3.
19. Ibid., pp. 4-5.
20. Alberta, Ministry of Health, Health Vision: Turning Ideas into Reality. Volume 1, Issue 3 (Edmonton: Queen's Printer, 1992), p. 7.
21. Ibid.
22. David Taras and Allan Tupper, "Politics and Deficits: Alberta's Challenge to the Canadian Political Agenda," in Douglas M. Brown and Janet Hiebert, eds., Canada, The State of the Federation, 1994 (Kingston, Ont.: Queen's University, Institute of Governmental Relations, 1994), p. 64.
23. Allan Tupper and G. Bruce Doern, "Alberta Budgeting in the Loughheed Era," in Allan M. Maslove and James Cutt, eds., Budgeting in the Provinces: Leadership and the Premiers. Monographs on Canadian Public Administration, No. 11 (Toronto: Institute of Public Administration of Canada, 1989), p. 131.
24. Marc Lisac, The Klein Revolution (Edmonton: NuWest Press, 1995), p. 43.
25. Mark O. Dickerson and Greg L. Flanagan, "The Unique Fiscal Situation of Alberta: Can Alberta's Deficit Reduction Model Be Exported?" Paper presented at the annual meeting of the Canadian Political Science Association, Montreal, May 1995, p. 11.
26. For an overview of this process, see Robert Mansell, "Fiscal Restructuring in Alberta: An Overview," in Christopher Bruce, Ronald Kneebone, Kenneth McKenzie, eds., A Government Re-invented: A Study of Alberta's Deficit Elimination Program (Toronto: Oxford University Press, 1997), p. 52; Lisac, The Klein Revolution, pp. 85-90.
27. Deficit Elimination Act, S.A. 1994, c. D-6.5.
28. Lisac, The Klein Revolution, Chapter 9.
29. Alberta, Health Planning Secretariat, Starting Points: Recommendations for Creating a More Accountable and Affordable Health System (Edmonton: Queen's Printer, 1993).
30. Regional Health Authorities Act, S.A. 1994, c. R-9.07.
31. Dennis Guest, The Emergence of Social Security in Canada, 3rd ed. (Vancouver: University of British Columbia Press, 1997).
32. David E. Osborne and Ted Gaebler, Re-Inventing Government: How the Entrepreneurial Spirit is Transforming the Public Sector (New York: Plume, 1992). For the Canadian variation of this trend,
33. see Peter Aucoin, "Beyond the 'New' in Public Management: Catching the Wave," in Christopher Dunn, ed., The Handbook of Canadian Public Administration (Toronto: Oxford University Press, 2002), pp. 37-52.
34. Alberta, Premier's Commission on Future Health Care for Albertans, The Rainbow Report: Our Vision for Health, Volume 2 (Edmonton: Queen's Printer, 1989), p. 116.
35. Ibid.
36. Leslie Gardner and Anna Russell, The Concept of Accountability: A Discussion Paper, Policy Development Division. Report for the Alberta Ministry of Health (Edmonton: Queen's Printer, 1989), MSS013U.RPT.29/RL r29/3/89.
37. Ibid., p. 3.
38. Ibid., p. 4.
39. Alberta, Department of Health, "Discussion Notes Accountability from Vision to Action," [unpublished and undated].
40. Alberta, Department of Health, Accountability in Alberta Health (Edmonton: Queen's Printer, 1991), p. 1.
41. The ideas developed in the 1989 document appeared almost word for word in a variety of later documents. For example, see Alberta, Department of Health, Managing the Health System: A Framework for the Provision of Effective Health Services to Albertans (Edmonton: Queen's Printer, 1991 and 1993).
42. On this topic, see Rich Goodkey, "The Alberta Perspective," in Luc Bernier and Evan H. Potter, eds., Business Planning in Canadian Public Administration. New Directions, No. 7 (Toronto: Institute of Public Administration of Canada, 2001), pp. 69-79;
43. and Ian Peach, Managing Complexity: The Lessons of Horizontal Policy-Making in the Provinces - The Scholar Series (Regina: Saskatchewan Institute of Public Policy, 2004), pp. 1-35;
44. and Kimberly Speers, "Performance measurement in the Government of Alberta," Gouvernance 2, no. 1 (July 2005), pp. 58-76.
45. Government Accountability Act, 1993. S.A. 1995 c.G-5.5.
46. Weiler, "From 'pressure group politics' to 'medical-industrial complex,'" Journal of Health Politics, Policy and Law, pp. 459-60.
47. Richard H.M. Plain, The Role Played by Health Reform in the Re-inventing of Government within Alberta (Ottawa: Health Canada, 1995).
48. Alberta, Department of Health, Alberta Health Roles and Functions of Health Services Delivery Organizations, p. 2.
49. Ibid., p. 3.
50. Alberta, Department of Health, Health Vision: Turning Ideas into Reality. Volume 1, Issue 2, pp. 2-3.
51. Alberta, Parliament, House of Assembly Debates and Proceedings, 23rd Legislature, 2nd Session, 9 May 1994 (Hansard) (Edmonton: Queen's Printer, 1994), p. 1764.
52. Taras and Tupper, "Politics and Deficits," in Brown and Hiebert, State of the Federation, pp. 61-83.
53. In fact, the original plan for fifteen regions was revised to seventeen to appease two MLAs.
54. Shannon Sampert, "King Ralph, The Ministry of Truth, and the Media," in Trevor Harrison, ed., The Return of the Trojan Horse: Alberta and the New World (Dis)Order (Montreal: Black Rose Books, 2005), pp. 37-51.
55. Don Martin, King Ralph: The Political Life and Success of Ralph Klein (Toronto: Key Porter Books, 2003), p. 179.
56. Ronald D. Kneebone and Kenneth J. McKenzie, "The Process behind Institutional Reform in Alberta," in Bruce, Kneebone and McKenzie, eds., A Government Re-invented, p. 181.
57. For a good discussion of this issue as it applies to Edmonton and surrounding municipalities, see Edward C. LeSage Jr. and Lorna Stefanick, "New Regionalist Metropolitan Action: The Case of the Alberta Capital." Paper presented at the annual general meeting of the Canadian Political Science Association, Winnipeg, 2004.
58. Alberta, Premier's Commission on Future Health Care for Albertans, The Rainbow Report: Our Vision for Health, Volume 2, p. 117.
59. Ibid., p. 119.
60. Alberta, Health Planning Secretariat, Starting Points: Recommendations for Creating a More Accountable and Affordable Health System (Edmonton: Queen's Printer, 1993), pp. 17-21.
61. Ibid., p. 17.
62. Alberta, Health Planning Secretariat, Action Plan: Part 1, 31 January 1994 (Edmonton: Queen's Printer, 1994).
63. In a subsequent reorganization, in 1999, the number of regions was reduced to nine.
64. In fact this mechanism was implemented once (1998), after significant public pressure, but subsequently abandoned.
65. Alberta, Health Planning Secretariat, Action Plan: Part 1, 31 January 1994.
66. Alberta, Health Plan Coordination Project, Task Force on Regional Governance, Report, Re: RHA Selection Processes (Edmonton: Queen's Printer, 1994).
67. Iain Gow, A Canadian Model of Public Administration? (Ottawa: Canadian School of Public Service, 2004), p. 11.
68. For example, the recent master agreement between the government and the profession formally recognized, for the first time, the Alberta Medical Association as the official representative of all physicians in Alberta.
69. Carolyn Tuohy, "Conflict and Accommodation in the Canadian Health Care System," in Robert G. Evans and Greg L. Stoddart, eds., Medicare at Maturity: Achievements, Lessons and Challenges (Calgary: University of Calgary Press, 1989).