Regionalization of health services in Newfoundland and Labrador: perceptions of the planning, implementation and consequences of regional governance.
OBJECTIVE
To describe the context and key drivers for regionalization of one provincial health care system in Canada; to document the original expectations of regionalization on governance and the extent to which these expectations were met; to identify the perceived successes and weaknesses of the process; and to examine the key issues and concerns that warrant further consideration and action in the future.


METHODS
Forty-five CEO/senior administrator or senior health department officials in the period 1993-2001 were invited to participate, of whom 35 were interviewed (67% of senior health officials and 85% of CEOs/senior administrators).


RESULTS
For the most part, key informants felt that expectations of reform with respect to reduction in the number of boards and integration of services under each board's mandate did occur. However, ongoing financial restraint, failure to include the full range of health services under the regional board mandate (including physician and pharmaceutical services), uncertainty regarding the level of authority the regional boards had for decision-making, and unclear accountability mechanisms between the regional boards and the provincial Ministry of Health limited the extent to which broader expectations related to development of a population health focus, and improved continuity of care for individuals and families was achieved.


CONCLUSIONS
Implications for policy-makers were identified in four main areas: alignment between health policy goals and the governance structure; clarification of authority and accountability relationships; clarification of roles and responsibilities among all key actors; and strengthening of mechanisms that support accountability.
Neville
Doreen
D
Division of Community Health, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada. dneville@mun.ca
Barrowman
Gwynedd
G
Fitzgerald
Brenda
B
Tomblin
Stephen
S
D000328:Adult; D001291:Attitude of Health Personnel; D003659:Decision Making, Organizational; D005260:Female; D018166:Health Care Reform; D006740:Hospital Administrators / Q000523:psychology; D006752:Hospital Planning; D006754:Hospital Restructuring; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009523:Newfoundland and Labrador; D015397:Program Evaluation; D012040:Regional Health Planning / Q000458:organization & administration*; D012941:Social Responsibility