Reforming Health Care Governance: The Case of Nova Scotia

Abstract

This article examines the place of decentralization and democratization as an element in the health care reform plans of one province, Nova Scotia, It begins with a brief review of the arguments for a different kind of state, one based on the principles of democratic administration, before considering the issues these arguments raise for health care governance in particular. Nova Scotia's health care system is situated within the broader Canadian context, and this essay notes the particular challenges, difficulties and opportunities for reform within this provincial setting. The essay provides an overview of Nova Scotia's health reform process, paying close attention to the various fiscal, political and administrative factors at work. It concludes with an assessment of the Nova Scotia case that duly notes both its accomplishments and failures, and the lessons, problems and prospects it may suggest for reforming health care governance elsewhere in Canada. Decentralization and democratization are not just about the ideal of citizen empowerment or the quality of democracy. They are also important to the long-term goals of cost containment and resource allocation, as well as the need to change the public's perception of the factors important to securing the health and well-being of their communities. While other policies must be pursued to accomplish all varied goals of comprehensive health care reform, moving towards a fully democratic and participatory system of health care governance continues to be central to its long-term success.