Health Care in Saskatchewan: An Analytical Profile.

K.V. Nagarajan is a professor in the Department of Economics at
Laurentian University.

Health Care in Saskatchewan is a detailed look at the system in the province that introduced the first public-insurance scheme in Canada. The authors write on highly charged issues in understated prose without raising anyone’s hackles. Hence, there is no advocacy of any particular path for policy-makers. The book is likely to appeal to mostly academics and health policy analysts.

The monograph opens with a comparative portrait of the health status of the population. Although the province was ranked third in terms of health indicators, it does not fare well in individual categories. The section on Aboriginal health status paints a grim picture, albeit in clinical language. Aboriginals constituting 13.5 percent of the population suffer disproportionately higher levels of morbidity and mortality. For example, Aboriginal infant mortality rate is 16 percent higher than the Canadian average. They relate the underlying cause to “poverty, marginalization and isolation.”

Moving on to organization and financing, they note that there is no single health care system in Saskatchewan. They also describe a structure in constant flux. From centralized control, the province has moved to regionalization in both funding and delivery. The Regional Health Authorities (RHAs) went down in number from 32 to 12 and moved from elected to appointed boards in 2002.

The RHAs were formed with the intention of moving the system away from the downstream illness care to upstream prevention and promotion of wellness. Many hospitals were shut down to enhance efficiency. Primary care reform with teams of health professionals was introduced to improve health care. To monitor performance, Saskatchewan created the Health Quality Council, the first of its kind in Canada.

Have these reforms delivered the goods? The authors are very guarded in their assessment of the success of these measures. “Given the limitations of data as well as the limitations of most performance indicators,” they write, “it is inherently difficult to come to any definitive conclusions concerning the quality and effectiveness of the Saskatchewan health system.” In short, we are still in the dark. No wonder they say that population health status has “some catching up to do.” There is no indication here how long it will take.