The democratization of public institutions : the case study of health care regionalization in Saskatchewan
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In 1993, the province of Saskatchewan reintroduced a program of regionalization within its health care system, partly in reaction to the current issue of fiscal constraints and partly in response to the notion of community based decision-making. The recent program of regionalization involved both a centralization of power and the devolution of decision-making. Indeed, over 400 institutional boards have been amalgamated into 32 regional health districts. At the same time, however, responsibilities for the provision of health care services and the allocation of funding were devolved to the regional health boards. The research question here is whether or not the structural reform served to democratize health care decision-making. The local structure may enhance the possibilities for deliberative participation in the determination of health care policy. Indeed, the placement of the newly formed regional health boards has certain positive and negative consequences. On the one hand, the district health boards areinstitutionally placed between the provincial government and the local community members, a situation that may allow for the development of Habermas' public forum. Here, all the stakeholders in the decision-making process may have the opportunity to have their concerns and interests included in the debates over service provision and resource allocation. On the other hand, control may simply be funneled from state to civil society, making the district health boards no more than the mouthpiece for provincial demands or indeed, private concerns (i.e. professional groups, interest groups, lobby groups). The concept of democratization was broken down into three themes that reflect the structural changes explicit within Saskatchewan's 1993 reform process: community participation, local elections, and devolution. The data was collected using a face-to face interviewing schedule which included both open and close-ended questions, and through the use of secondary data. The members from two regional health boards in Saskatchewan were interviewed. The responses reveal that there is some evidence that regionalization provides a normative structural model for deliberative democratization. It is the practical application of deliberative methods that needs further investigation. There are many intrinsic problems that need to be further explored, for instance, the issue of political legitimacy and political apathy.