Abstract
The health policy New Directions committed the British Columbia government to a population health perspective and extensive community involvement in the health services reform process. The policy envisaged elected citizen boards with authority to raise revenues and exercise a significant degree of local autonomy. Academic and public attention has been paid to the decision in November 1996 to collapse New Directions’ two-tier governance structure into a single level. Less attention has been paid to the profound changes that occurred prior to the government’s reversal on the question of governance. This paper focusses on those changes. During the critical three years between the 1993 launch of the reform and its formal revision in 1996, the government’s positions on elections, taxation power, local autonomy and scope of action for regional boards all changed. Those changes marked a retreat from political accountability to the community and an advance towards managerial accountability to the government.
Abrégé
La politique de santé « New Directions » avait engagé le gouvernement de la Colombie-Britannique dans une perspective de santé de la population et de participation intensive de la communauté au processus de réforme des services de santé. La politique prévoyait l’élection de conseils de citoyens dotés des pouvoirs de générer des revenus et d’exercer un niveau significatif d’autonomie locale. L’attention académique et publique a été attirée, en novembre 1996, sur le fait que la structure d’autorité prévue dans « New Directions » avait été réduite de deux niveaux à un seul. Moins d’intérêt a été porté aux changements profonds qui se sont produits avant que le gouvernement ne révise la structure décisionnelle. Cet article se concentre sur ces changements. Pendant les trois années critiques entre le lancement de la réforme en 1993 et sa révision formelle en 1996, le gouvernement a changé sa position au sujet des élections du pouvoir d’imposition, de l’autonomie locale et de la portée des actions des comités régionaux. Ces changements ont marqué un recul au plan de la responsabilisation politique vis à vis de la communauté et un progrès de la responsabilisation de l’administration vis à vis du gouvernement.
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