Health care planning is undertaken by each provincial and territorial ministry of health as part of
its responsibility for the operation of the health care system. It generally takes one of two forms:
routine operational and capital planning, or specialized planning initiatives.
Routine planning tends to be sectoral rather than systemic. Planning for hospital services,
physician services, community-based services, etc., usually takes place separately and within
separate budgetary envelopes.
The independence of predominately private medical practitioners has limited the ability of
governments to control the numbers and cost of physicians practising in a province. The
development of a recent federal/provincial/territorial action plan on medical resources, and
subsequent negotiations with medical associations, have led to the development of physician
resource plans in many provinces. These plans have curtailed the level of medical school
enrolment and made recommendations to limit the number of practising physicians, alter their
geographic dispersion and reduce immigration levels for foreign medical students and physicians.
Some provinces have unilaterally imposed or threatened to enforce restrictions on numbers and
locations of physicians.
Planning in the hospital sector is subject to many of the same challenges as the medical sector, as
most hospitals are privately owned nonprofit organizations. Allocation of resources within each
institution tends to be at its own discretion. This is tempered at the provincial level, however,
by
splitting the planning process into operational and capital planning. Thus, while day-to-day
operations are largely institutionally based with some input from the ministry, the decision to
build and update facilities or purchase new equipment is subject to more extensive central
control. Therefore, even though the institutional sector accounts for the preponderance of
provincial health care budgets, provinces have had more planning and financial control than in
any other sector.
The sectoral approach to health care planning has often led to inconsistencies among the goals
and objectives of governments as each sector has been planned within its own "stove pipe"
without considering the influence of or impact on other sectors. Planning is also complicated by
the way the "contract model" has traditionally been implemented in Canada. Governments have
tended to act more as "payers" than as "purchasers" of health care services, thereby limiting their
ability to plan the mix and volume of health services. Budgetary constraints in recent years have
added to the difficulty in planning, but at the same time have highlighted the need for
comprehensive, systemic health care planning.
Many provinces are exploring new ways of strategic planning. Some have created health
researcher panels to assist in and guide the planning process. Several provinces have developed
planning frameworks to lead any reform efforts. Others have developed population health goals
and established provincial health councils. In some jurisdictions, certain planning functions have
been transferred to subprovincial units or planning councils, as part of a general trend toward
increased health care decentralization in Canada.
There is also some experimentation with needs-based planning, a planning process which uses
objective measures to assess the actual need for health care services in a specified area.
Typically, the measures used for this process include age, sex, and mortality or morbidity.
At
least one province has formally adopted needs-based planning as the basis for regional allocation
of resources.
Specialized planning in the form of special reviews, commissions or task forces, has occurred
sporadically in the Canadian health care system. The 1964 Hall Commission, for example, was
largely responsible for leading to the creation of Canada's national health insurance system.
10 Health care systems in transition – Canada
During the 1980s and early 1990s, almost all provinces engaged in an in-depth review of their
health care systems, largely in response to provincial fiscal pressures that were demanding reexamination of all public spending. What is striking about these reviews is their virtual unanimity
in recommending the need for greater efficiency and restructuring of the health system, within
current budgets, away from a focus on treatment oriented, institutionally based health care
towards community-based care with a focus on promotion and prevention. In many provinces
these reviews formed the basis for subsequent health system reforms undertaken in the 1990s.
The federal government is also participating in a planning initiative at the national level. In 1994,
a National Forum on Health was created with a mandate to develop a new vision for Canada's
health system for the 21st century. Chaired by the Prime Minister and the Minister of Health, the
24-member National Forum is expected to report its findings early in 1997.
Most regulation of health care is done at the provincial level. The federal government's regulatory
responsibilities include ensuring the safety and efficacy of drugs and medical devices and
regulating the prices of patented medicines (this stems from the federal government's jurisdiction
with respect to patents).
There is no formal regulatory body for the prices of nonpatented drugs
which fall under the jurisdiction of the provinces.
While provinces have overall responsibility for regulation with respect to health care, many of
those responsibilities have been delegated especially in the area of professional services.
Appropriate legislation sets out the general parameters for each profession which are normally
maintained by professional bodies with some minimal supervision from the provinces. Physicians,
for example, are regulated and certified by their own professional colleges, while their medical
associations negotiate with each province about planning and remuneration. Hospitals are
regulated via public hospital acts, but the accreditation process is nongovernmental. The
proliferation of private clinics that are capable of providing many services previously available
only in hospitals, has led many provinces into the area of direct regulation to control location,
ownership, quality and patient charges.
