The “big bang” of health-care reform in Saskatchewan is over, says a University of Regina administration professor.
Ken Rasmussen told delegates to the Saskatchewan Association of Health Organizations annual convention last week that reform will proceed at a slower pace now that the district health boards are taking over from the province.
“I think the key is going to be a continuous, low-profile, marginal change,” he said, rather than the hospital and bed closures of the past four years.
“The ultimate conclusion … that I make is that the creation of a fragmented and a diffuse system of decision making that’s more open to interest-group participation means that district health boards are unlikely to be bodies that propose radical changes.”
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Local decision-making
The formation of health districts represents a shift in health politics, Rasmussen said. Health moved from a centralized system of bureaucratic power to a new one based on the notion of citizenship, community and local decision-making.
He said health districts that succeed in the new system will be those with high levels of social capital, defined as “the networks, norms and trust that enable people to act together.”
Rasmussen said social capital is identified by high levels of voter turnout, volunteerism, newspaper readership, education and social trust.
“In communities where there is a declining social capital you also have a decline in civic engagement,” he said.
“That’s really troubling for a body that was created in order to engage a civic population.”
He said health boards need to connect with their constituents, but they aren’t doing that yet. In a 1994 provincial survey, 66 percent of people agreed the health-care system would improve with more community control. Two years later, only 48 percent strongly or moderately agreed with the same statement.
“I think it’s something that district health boards should be aware of in their deliberations, that perhaps they haven’t yet made the contact, the connections, with the community, and people are not as convinced of the value at this point of district health boards.”
He said voter turnout in health board elections in October is one indicator of the legitimacy of the boards. Voter apathy is a concern because low turnout does not provide a mandate for change.
“It’s very difficult to argue for some kind of a positive change if you’re getting 15 percent of the voters turning out,” Rasmussen said.
He also cautioned the boards about powerful interest groups. People are cynical about politicians and the political system and are turning to these types of groups for representation. He said legitimacy will suffer if boards are influenced too much by these groups.
While a strong centralized government can withstand opposition to actions like spending cuts or facility closures, health boards cannot.
“I think health boards have the potential of becoming veto points in the whole process,” Rasmussen said. “They may allow vested interests to veto major transformation.”
He also said health-care reform will continue largely for the same reasons it always has – competition. Those boards that can face opposition and develop new ideas, pilot projects and programs will see their programs adopted by other districts.
