Other countries are looking at different strategies for reorganizing their health care services and, pointed out Lomas, using different buzzwords. Saskatchewan and Prince Edward Island have delegated responsibility for financial allocation and service delivery to district health councils. Lomas said there are now about 116 devolved authorities across Canada. Their degree of independence varies all the way from service delivery to providing policy advice. In a few instances in British Columbia, it even includes revenue-raising autonomy.
Different provinces offer different models.
British Columbia has chosen to delegate some powers to the regional level and some to the local level, so there are two layers of bureaucracy reporting to the provincial ministry. Provincial governments surrender power reluctantly, but as regional or local authorities pick up steam, they are more likely to let community priorities outweigh provincial ones. Raisa Deber, professor of health policy at the University of Toronto, raised fundamental issues about health care reform. If the conference's audience of physicians, administrators and planners nursed any optimism about the process of health care reform, remarks by England's Maynard were guaranteed to kill it. And for the past 50 years, the political response to the crisis has been to re-disorganize.