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Just Out of the Starting Blocks: Advancing Province-Wide Integrated Health and Social Services Governance in Quebec. 刚刚走出起点：推进魁北克省全省综合卫生和社会服务治理。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27697
Elisabeth Martin
{"title":"Just Out of the Starting Blocks: Advancing Province-Wide Integrated Health and Social Services Governance in Quebec.","authors":"Elisabeth Martin","doi":"10.12927/hcpap.2025.27697","DOIUrl":"10.12927/hcpap.2025.27697","url":null,"abstract":"<p><p>In December 2024, Santé Québec (SQ), a province-wide agency overseeing health and social services delivery, was launched. Denis's essay offers an insightful and valuable lens to analyze the reform's underlying assumptions and to reflect on the opportunities and challenges ahead. SQ aims to separate policy making and planning from service delivery, a distinction that may prove difficult in practice. Moreover, the infrastructure for meaningful decentralization might be lacking, given Quebec's health system legacy of extensive structural integration. Nonetheless, existing assets - such as health regions, population-based responsibility and local health and social services networks - could prove to be valuable tools for stakeholder engagement and innovation.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"66-71"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative Perspectives on Health Governance as Political Practice: A Commentary. 卫生治理作为政治实践的比较视角述评
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27704
Viola Burau
{"title":"Comparative Perspectives on Health Governance as Political Practice: A Commentary.","authors":"Viola Burau","doi":"10.12927/hcpap.2025.27704","DOIUrl":"10.12927/hcpap.2025.27704","url":null,"abstract":"<p><p>Health governance is political as it is tied to goals specific to individual health systems. The best health governance is context-specific. Health governance is a collective practice that involves stakeholders across levels and sectors. The universality of health governance offers great opportunities for learning across jurisdictions. The view across borders is best at inspiring self-reflection about what is good enough health governance in one's health system. Health governance affords political and administrative crafts(wo)manship, drawing on in-depth knowledge of one's health system, excelling at collaboration and being open to experiences from other jurisdictions as a tool of self-reflection.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Broadening the Analysis of Canadian Healthcare Reforms. 拓宽对加拿大医疗改革的分析。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27698
Mark Exworthy, Russell Mannion
{"title":"Broadening the Analysis of Canadian Healthcare Reforms.","authors":"Mark Exworthy, Russell Mannion","doi":"10.12927/hcpap.2025.27698","DOIUrl":"10.12927/hcpap.2025.27698","url":null,"abstract":"<p><p>Analysis of any healthcare reform is complex and multi-faceted. Given the hierarchical levels in health systems (regarding funding and accountability, etc.), a key analytical dimension is between decentralization and centralization. Reforms can be justified on either, often for the same criteria (such as equity or economy). The impact of decentralization/centralization can be assessed by determining \"what\" is being (de)centralized and from/to whom. This article appraises the analysis of Canadian healthcare reform by Denis, in terms of the TAPIC (Transparency, Accountability, Participation, Integrity and Capability) and decision space frameworks. It draws attention to the importance of incentives, context and implementation in this (and other) reform program.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"60-65"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Of Big and Small Swings: Toward a Hybrid View of Healthcare Systems Governance. 大波动和小波动：对医疗保健系统治理的混合观点。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27699
Jean-Frederic Levesque
{"title":"Of Big and Small Swings: Toward a Hybrid View of Healthcare Systems Governance.","authors":"Jean-Frederic Levesque","doi":"10.12927/hcpap.2025.27699","DOIUrl":"10.12927/hcpap.2025.27699","url":null,"abstract":"<p><p>The governance of healthcare systems is inherently complex and often leads to recurring debates about the advantages and pitfalls of centralization and decentralization to address politicization in healthcare. The international experience provides insights to reflect on the analysis of the recent reforms in the Canadian context, such as the one by Jean-Louis Denis. In this commentary, we argue that creating massive structures to shield operational management from political interference generates challenges related to the multilevel nature of decision making and the re-creation of siloes. Hybrid approaches may provide checks and balances and achieve the objectives of both centralization and devolution.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"53-59"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three Readings of the Concept of Governance. “治理概念”的三种解读。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27703
Damien Contandriopoulos
{"title":"Three Readings of the Concept of Governance.","authors":"Damien Contandriopoulos","doi":"10.12927/hcpap.2025.27703","DOIUrl":"10.12927/hcpap.2025.27703","url":null,"abstract":"<p><p>This commentary builds on Jean-Louis Denis' comprehensive review of the Canadian health governance literature to explore three interpretations of its function: as an analytical tool, a guide for structural reform and a symbolic or divinatory discourse. While the built-in flexibility of the concept of governance enables cross-provincial comparisons in structurally diverse systems, its high level of abstraction risks diluting its practical value. As a guide for reform, the literature struggles to offer cumulative, actionable knowledge. The commentary then examines the possibility that governance discourses serve more to legitimize political decisions than to inform them, functioning rhetorically rather than empirically.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Big Swing Toward Centralized Governance: What We Heard From Rural Saskatchewan Healthcare Workers. 向集中治理的大转变：我们从萨斯喀彻温省农村医疗工作者那里听到的。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27701
Tom McIntosh, Cheryl A Camillo, Nuelle Novik, Bonnie Jeffery, May Ly
{"title":"The Big Swing Toward Centralized Governance: What We Heard From Rural Saskatchewan Healthcare Workers.","authors":"Tom McIntosh, Cheryl A Camillo, Nuelle Novik, Bonnie Jeffery, May Ly","doi":"10.12927/hcpap.2025.27701","DOIUrl":"10.12927/hcpap.2025.27701","url":null,"abstract":"<p><p>This paper links the \"provisional learnings\" outlined in Denis's lead article to the results of a mixed-methods study of the state of rural healthcare in Saskatchewan to examine the manner by which the province centralized health system governance in 2017. While the study has limitations that preclude any hard and fast conclusions about those changes, there is evidence to suggest that the reforms were undertaken with insufficient attention to the particularities of rural healthcare organization and delivery. Amalgamation is not the sole cause of Saskatchewan's current crisis in rural healthcare, but the way it was implemented (with little consultation with rural communities, without clear goals and without sufficient planning in advance) may have exacerbated an already worsening situation.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"40-45"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alberta: The Next Reform Is Always Just Ahead. 艾伯塔省：下一次改革总是在前方。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27702
Neale Smith, John Church
{"title":"Alberta: The Next Reform Is Always Just Ahead.","authors":"Neale Smith, John Church","doi":"10.12927/hcpap.2025.27702","DOIUrl":"10.12927/hcpap.2025.27702","url":null,"abstract":"<p><p>Over the last several decades, Alberta has led Canadian provinces in waves of healthcare system reform: first to regionalize, first to replace regions with a province-wide health authority and, in 2024, first to blow up such an authority for a new combination of functionally based organizations. Yet behind the flux in organizational forms lies a consistent set of storylines. On the surface, reforms have continually tried to find ways to facilitate the transfer of resources from the acute care sector to other components of the health system. Less openly, changes from the Klein government onward appear to be intended to facilitate greater political control over health bureaucrats and professionals, and to pave the way for an expanded private sector role.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"34-39"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Big Swing: Reforming Governance Authorities in Canadian Health Systems. 大转变：改革加拿大卫生系统的管理当局。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27705
Jean-Louis Denis
{"title":"The Big Swing: Reforming Governance Authorities in Canadian Health Systems.","authors":"Jean-Louis Denis","doi":"10.12927/hcpap.2025.27705","DOIUrl":"10.12927/hcpap.2025.27705","url":null,"abstract":"<p><p>The governance of publicly funded health systems in Canada has attracted attention for decades. Governance refers to the steering of the whole health system and goes beyond the role of healthcare boards for hospitals or regions. In this article, we analyze the potential of system-level reforms of governance that have been implemented in seven Canadian provinces since 2008. These reforms involve a movement toward greater centralization of the governance of health systems with the creation of province-wide governing agencies. These reforms of governance are not, by design, a panacea nor an absolute policy mistake. The potential of these governance reforms, as with any structural changes, will largely depend on how actors in power inhabit these new agencies and how patients, citizens, non-governmental organizations and communities relate to them. To assess the potential of these reforms, we first review works on challenges faced by these new health authorities. We then explore the literature on high-performing health systems and on contemporary approaches to governance, offering guidance for leaders of these organizations.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"10-22"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How to Achieve Meaningful Change. 如何实现有意义的改变。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27696
Gregory P Marchildon
{"title":"How to Achieve Meaningful Change.","authors":"Gregory P Marchildon","doi":"10.12927/hcpap.2025.27696","DOIUrl":"10.12927/hcpap.2025.27696","url":null,"abstract":"<p><p>Over the past four decades, the most significant organizational change has been the establishment of health authorities that have been delegated by provincial governments to manage health systems. The continual changes made to the structure of health authorities, including the recent trend to more centralized administration, have caused considerable upheaval. Although a major change in the immediate future would only amplify this upheaval, it is still worth delegating to health authorities the additional responsibility for the payment and management of health human resources, including physician remuneration and bargaining. This is one more incremental change that holds the greatest promise in terms of improving accountability and health system performance.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"72-76"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Governance - The Good, the Bad and the Ugly. 治理-好的，坏的和丑陋的。
HealthcarePapers Pub Date : 2025-08-01 DOI: 10.12927/hcpap.2025.27706
Sara Allin, Audrey Laporte
{"title":"Governance - The Good, the Bad and the Ugly.","authors":"Sara Allin, Audrey Laporte","doi":"10.12927/hcpap.2025.27706","DOIUrl":"10.12927/hcpap.2025.27706","url":null,"abstract":"<p><p>This issue of HealthcarePapers tackles the challenging question about how to strengthen health system governance in Canada and helps to make sense of the wave of structural reforms underway across the country. The lead essay and commentaries in this issue provide the much-needed empirical and experiential evidence on the intended and unintended effects of reforms to governance, with a focus on the recent wave of centralization of regional authorities across provinces. This issue provides the necessary tools for health system leaders to maximize the potential of these new governing agencies.</p>","PeriodicalId":101342,"journal":{"name":"HealthcarePapers","volume":"23 2","pages":"5-8"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145350988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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