State-funded healthcare systems increasingly recognize accountability as an important public policy issue. This article explores significant aspects of current theory and practice in order to describe an accountability framework for the Canadian health system. Stakeholders include governments, institutions, providers and patients. Their relationships may be framed in constitutional, political, financial, managerial, clinical or ethical terms. The specific processes and instruments to operationalize accountability depend on the terms by which it is framed.
Get full access to this article
View all access options for this article.
References
1.
Auditor General.Reflections on a decade of serving Parliament. Ottawa: Government of Canada; 2001.
2.
FloodCM. International healthcare reform, a legal, economic and political analysis. New York: Routledge; 2000.
3.
DayPKleinR. Accountabilities, five public services. New York: Tavistock; 1987.
4.
RelmanAS. Assessment and accountability, the third revolution in healthcare. New England Journal of Medicine1988; 319: 1220–22.
5.
DanielsNSabinJ. The ethics of accountability reform in managed care reform. Health Affairs1998; 17: 50–64.
6.
EmanuelEJEmanuelLL. Preserving community in healthcare. Journal of Health Politics, Policy and Law1997; 22: 147–184.
7.
GraceJ. Accountability and independent review. Optimum, The Journal of Public Sector Management1993; 24: 80–85.
8.
ParboosinghJStachenkoSInhaberS. A model of consumer participation: The Canadian Breast Cancer Institute. Canadian Journal on Aging1997; 16: 177–186.
9.
FinnTD. Independent review agencies and accountability: Snapping at the heels of government?Optimum, The Journal of Public Sector Management1993; 24: 9–22.
10.
AucoinP. Securing accountability. In: AucoinP. The new public management in Canada: A comparative perspective. Montreal: Institute for Research on Public Policy; 1995. p. 217–242.
11.
CarmenRD. Accountability of senior public servants to Parliament and its committees. Canadian Public Administration1984; 27: 542–55.
BensCK. Comprehensive auditing: A management approach for improving accountability. Government Finance Review1991 Mar:9–12.
14.
RaynerM. Evaluation in Canada. Evaluation Practice1986; 7: 45–56.
15.
BanksB. On guard for thee, a powerful new lineup of auditors faces off against deep deficits, high taxes and government mismanagement. CA Magazine1994 Jan/Feb:25–37.
16.
DuboisR. Accountability in Parliament: The role of the Auditor General. Canadian Parliamentary Review1990; 13: 28–29.
17.
GingellF. Getting results: Accountability reporting can help politicians identify those expenditures that need to be cut. CA Magazine1995;May:33–34.
18.
CharihM. The policy and expenditure management system: Lessons from experience. Optimum, The Journal of Public Sector Management1992; 22: 50–56.
19.
LomasJ. Reluctant rationers: Public input to healthcare priorities. Journal of Health Services Research and Policy1997; 2: 103–111.
20.
MuellerCB. Some effects of health insurance in Canada — from private enterprise toward public accountability. New England Journal of Medicine1978; 298: 535–539.
21.
Canada. A framework to improve the Social Union for Canadians. Ottawa: 1999.
22.
Intergovernmental Conference Secretariat.First Ministers' meeting communiqué on health News Release 800-038/004. Ottawa, 2001. [available at: http://www.scics.gc.ca/cinfo))/80038004_e.html]
23.
Alberta Department of Health.Achieving accountability in Alberta's health system. Edmonton: The Department; 1998.
24.
British Columbia Ministry of Health and Ministry Responsible for Seniors.Accountability framework for British Columbia health authorities. Victoria: The Ministry; 1998.
25.
Manitoba Department of Health.Achieving accountability. Winnipeg: The Department; 1999.
26.
Nova Scotia Department of Health.Accountability in Nova Scotia's health system. Halifax: The Department; 1997.
27.
Saskatchewan Department of Health.A framework of accountability. Regina: The Department; 1995.
28.
McCandlessHWrightD. Enhancing public accountability. Optimum, The Journal of Public Sector Management1993; 23: 110–118.
29.
BeaulneJP. The RCMP Public Complaints Commission. Optimum, The Journal of Public Sector Management1993; 24: 58–96.
30.
StenningPC. Some reflections on accountability in the Ministry of the Solicitor General of Canada. Optimum, The Journal of Public Sector Management1992; 23: 41–57.
31.
KernaghanKL. The accountable public servant. In: KernaghanKL. The responsible civil servant. Montreal: The Institute for Research on Public Policy and the Institute of Public Administration of Canada; 1990. p. 157–181.
32.
MitchellJR. Accountability. Optimum, The Journal of Public Sector Management1992; 23: 2–16.
33.
SawyerDMWilliamsJR. Core and comprehensive healthcare services: 3. Ethical issues. Canadian Medical Association Journal1995; 152: 1409–1411.
34.
Canadian Institute for Health Information.The evolution of public and private healthcare spending in Canada, 1960 to 1997. Ottawa: The Institute; 1999.
35.
LomasJWoodsJVeenstraG. Devolving authority for healthcare in Canada's provinces: 4. Emerging issues and prospects. Canadian Medical Association Journal1997; 156: 817–823.
CrollK. Elected or appointed? The case for healthcare trustees. Leadership1996 Mar-Apr:7–12.
38.
WilsonVS. Public administration reform and the “new managerialism”: A comparative assessment of a fundamental challenge confronting Canadian public administration. International Journal of Public Administration1996; 19: 1509–1553.
39.
AtkinsonAAMcCrindellJQ. Strategic performance measurement in government. CMA Magazine1997 Apr:21–3.
40.
PriceESMcAdamsLP. Bringing accountability results to government in British Columbia. Public Administration and Development1996; 16: 305–315.
41.
GibsonFE. Independent review and accountability: Conditional release in transition. Optimum, The Journal of Public Sector Management1993; 24: 70–79.
42.
SutherlandSL. The evolution of program budget ideas in Canada: Does Parliament benefit from estimates reform. Canadian Public Administration1990; 33: 133–164.
43.
BakerGRBrooksNAndersonGBrownAMcKillopIMurrayM. Healthcare performance measurement in Canada: Who is doing what?Hospital Quarterly1998–99; 2: 22–26.
44.
NobleR. Executive performance: The demands of the 1990's. Healthcare Management Forum1990; 3: 16–20.
45.
IslamN. Performance contract: Conceptualization of the government-public enterprise interface. Optimum, The Journal of Public Sector Management1993; 23: 53–59.
46.
RodalAMulderN. Partnerships, devolution and power-sharing: Issues and implications for management. Optimum, The Journal of Public Sector Management1993; 24: 27–48.
47.
ShorttSE. Alberta's Bill 11: Will trade tribunals set domestic health policy?Canadian Medical Association Journal. 2001; 164: 798–99.
