Obtaining Effective Medical Input Into Regional Decision Making

The ongoing lack of effective public and professional input into regional health care decision-making is of considerable concern. For example, although Regional Health Boards (RHBs) and Community Health Councils (CHCs) have been in place for more than 3 years, at time of publication 6 of BC’s health authorities still do not have functioning Regional Medical Advisory Committees (RMACs). Many RMACs have only recently been struck and there remain significant concerns regarding composition and the lack of a direct reporting relationship to the health board. Prior to regional governance, all BC hospitals had functioning Medical Advisory Committees that reported directly to the Board. This marks a significant loss of practising physician input into quality of care and policy decisions at the local level. The RMAC is a critical source of input into regional decision-making and, to be effective, must include a direct presence at the Board level. Experience in other jurisdictions has shown that, unless effective practising physician input is obtained, local health care governance cannot succeed.

Several medical decision-making structures exist, both locally and provincially, that must be incorporated into the regional health decision-making process. These bodies include local medical staffs, regional medical advisory committees (RMACs), local medical societies, and the Doctors of BC. In addition to negotiations, which tends to draw most of the public’s attention, the Doctors of BC is a long-standing source of expertise in health policy development, communications, economic analysis and professional relations. The Doctors of BC is an integral provincial resource for both practicing physicians and regional health authorities. Local health decision-making can be enhanced through the input of the Doctors of BC.

On a positive note, and as a result of significant public and provider pressure, BC’s health authorities now include a physician as a voting member on the board of governors. This has served to improve the Boards’ understanding of the implications of their decisions with respect to quality of care. Unfortunately, there is little transparency and considerable uncertainty regarding the re-appointment process of these physician representatives. It is crucial that physician board members have the confidence of their medical staff(s) through direct election by their peers.

To date, de-centralized health governance in BC has created considerable uncertainty regarding the decision-making process. It is recognized, however, that regionalization is also an opportunity for strategic alliances between the medical profession and regional health authorities. It is essential that both groups recognize each other’s integral role and expertise in BC’s evolving health system. We must collectively make strides to regain the necessary level of public and professional input into local decision-making to ensure the quality of patient care and the best use of scarce health care resources.

The Doctors of BC makes eight recommendations to re-establish effective, necessary input into local health decision-making.

For the full policy paper, please see “Obtaining Effective Medical Input Into Regional Decision Making”.