Globalization has become a ubiquitously word in the last few decades. Much of the globalization trend is driven by the fact that many organizations operate internationally and supply chains have become sophisticated, complex, and spans the entire globe. Globalization trends are starting to become more widespread and ever easier to implement due to advancement in information technology. Globalization and its effects have paved the way for increased free trade agreements and comparative advantages in various goods between different countries and nations. As a result of globalization, markets attempt to proactively create a level of homogenization and standardization of resources and labor. However, globalization and standardization are ill-equipped to handle all goods and services that are desired by the public.
Some industries, such as healthcare and education, are not easily fit into a standardized model. Such industries require flexibility to adapt to specific challenges that may only apply to a region or to a specific group. The health care system of Canada was restructured in 1996 to streamline the delivery system making it less fragmented. This would make it more responsive to local needs such as increasing community-bases services, improving public participation, and promoting health lifestyles through programs and policies. This analysis will outline some of the pros and cons that inherent in a regionalized strategy as well the perceived benefits that were intended to be gained by its implementation in Canada. It will also consider regionalization in other industries such as in education.
The rise in the popularity of the concept of regional innovation systems has been in part driven by the increased intensity of international competition in a globalizing economy, the apparent shortcomings of traditional regional development models and policies, and the emergence of successful clusters of firms and industries in many regions around the world The healthcare system in Canada was facing major challenges in the 1990s. In Canada, regionalization of healthcare has entailed more than devolution and decentralization of services from provincial governments to regional authorities (Doloreaux & Parto, N.d.).
It included consolidation of authority from local boards and agencies, and some centralization of services (Lewis & Kouri, 2004). Many analysts called for a reform of the system and its design because of the way it was being managed and the quality of healthcare delivery. Some of the most common problems that occurred in the system were the accessibility and major delays, of many treatments, difficulty accessing some services in a timely manner that were primarily a result of inconsistent coordination of the system. Quality, access, and sustainability have been common problems that have been experienced worldwide (Dash, Llewellyn, & Richardson, 2009).
Regionalization was suggested at first by the Royal Commission on Health Services in 1964 and by the Task Force on the Cost of Health Services in 1969. The purpose of the Royal Commission was to (Health Canada, N.d.):
... inquire into and report upon the existing facilities and the future need for health services for the people of Canada and the resources to provide such services, and to recommend such measures, consistent with the constitutional division of legislative powers in Canada, as the Commissioners believe will ensure that the best possible health care is available to all Canadians ...
There were four primary reasons identified which served as the basis in which regionalization responded to. The first reason was to promote better health through increased health promotion and prevention of injury and illness. There have been many strategies that can work in a proactive manner to increase the overall health of the public whereas many forms of medical treatments are provided in more of a reactive manner. Some proactive activities include education, communication, community development, and public education.
Another reason was to involve the public more through local participation and community responsibility. The author of Public Health and Preventative Medicine in Canada, Chandrakant P. Shah states three initiatives that will increase citizen involvement: knowledge about the cause of disease, participation in the formulation of health care policies and the creation of citizen voluntary groups (Chandrakant, 2003). Another initiative works to bring health closer to where people live. Some services can be provided directly in people's homes while others are provided in the local communities and regional level.
The last reason identified was the need to establish an effective and efficient management system. Management can ensure that accountability and transparency are injected into the system as well as make better use of health care resources. In 2001 the Minister of Health Planning announced that more than fifty regional health authorities would be cut down to one provincial health authority, five geographic health authorities and fifteen health service delivery areas. The five health authorities are: Northern Health Authority, Interior Health Authority, Fraser Health Authority, Vancouver Coastal Health Authority and Vancouver Island Health Authority. This would improve efficiency, strengthen accountability and allow better planning and service coordination for patients (Ministry of Health Planning, N.d.)
The organizational structure changes were the most significant evolution within regionalization. Some of the planning of different goals and standards are still centralized such as provincial goals and accountability for meeting those goals. However, for the most part, the Ministry of Health (MOH) has diluted its power and given it to the regional organizations. The local organizations are fully accountable for their regions system design, care, and treatment and for regional populations. This given communities flexibility to design their health care systems to respond to the specific challenges that they face on a local level.
In Newfoundland, there are publicly funded Health and Community Services are delivered across Newfoundland and Labrador by four regional health authorities. The services include (Department of Health and Community Services, N.d.):
Acute Care Hospital Services
Long-Term Care Services
Contact Information - Regional Health Authorities
Acute care provides services that require quick medical assistance such as the case with accidents. Long-term care services are provided for those that are in need for care over a long duration of time. Community-based services include (Department of Health and Community Services, N.d.):
Child Care Services
Mental Health and addictions services
Community Support Program
Community Health Nursing Services
Satellite Renal Dialysis Services
The public health services are created to promote healthy lifestyles as well as a sense of well-being. The areas range from personal health that include information on various diseases and vaccinations, all the way to environmental health issues such as rodent control and air quality
The emerging structures and their effectiveness have been the subject of a lot of debate. Regionalization has been put forward as the means by which provincial governments will be able to cure many of the problems plaguing the health care system, yet very little research is available to supply evidence that regionalization is the method by which these problems can be fixed. In September 2003, the Canadian Centre for Analysis of Regionalization and Health (CCARH) stated (Society of Rural Physiscians, 2004)
"Many changes in health region boundaries have been implemented without a strong evidence base. Yet the implications for the effectiveness of regionalization policy are great. Not the least of these is the destabilization to health delivery systems that is wrought by the constant changes. (Newsletter, CCARH, Sept2003)
However, others argue that it is simply too complicated of a system to judge whether or not the changes have been successful. Except for Alberta and Prince Edward Island, which have abandoned regional models, all provinces use some variant of regionalization. But how the regional model is implemented varies widely. Some experts say this is to be expected, as the health care needs of provinces also vary widely, but note that the lack of uniformity makes it difficult to give an effective answer to the question…