The big bang approach to health reform: an update from the Calgary Regional Health Authority.

Does It Work? The Case of Britain’s 1991 National Health Service Reforms,” Rudolf Klein described health reform as one of the worldwide epidemics of the 1990s. Klein’s description of the new National Health Service model as a self-inventing institution, coupled with the powerful images on Canadian television in October 1998 of the Calgary General Hospital’s implosion, make his article an apt starting point for a preliminary assessment of the impact of health restructuring in Calgary. In describing Britain’s health reform, Klein noted the Thatcher government intentionally resisted formal evaluation of the impact of the changes. The creation of internal markets within the NHS was implemented in a way that frustrated attempts at evaluation. The Calgary Regional Health Authority (CRHA), believing that the government of Alberta expected a more integrated and fiscally responsible health system, has taken a number of significant actions (exemplified by the fate of the Calgary General Hospital), in response to regionalization. The changes to date in Region 4 (the area served by the CRHA see map) have been driven by reduced per capita funding, and a commitment to protect quality while creating a foundation that supports a sustainable health system in the future. As was the case in Britain, the absence of a provincial or national system to monitor the impact of regionalization in Canada is striking. This article will describe health restructuring in Alberta, using the experience of the CRHA to illustrate some successes and ongoing challenges associated with regionalization in one of Canada’s fastest-growing urban areas. It will close with a review of some issues associated with the CRHA’s effort to fulfill its mandate under the Regional Health Authorities Act which calls for the CRHA to serve as both health system manager at the local level and a major service provider on a broader scale.