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In the early 1990s Canada was in a recession and the government of Saskatchewan felt the pressure of a growing deficit. In 1992, the provincial government decided to reduce the health care budget by 3.3%. The following year, the government undertook regionalization of health care services through the Health Districts Act, with a focus on promoting preventative health care rather than solely treatment-based care. The budget cuts resulted in the closure of 52 rural hospitals, leading to a public outcry. Evaluations of the reform were not able to show a definite detrimental effect on health outcomes in the corresponding communities. Community members expressed increased caregiver burden, travel costs and travel time to the next nearest hospital, and potential inequalities in access to care. When undertaking reform, it is important that government consider the voices of local communities in the decision-making process. Au debut des annees 90, le Canada etait en recession et, en Saskatchewan, le deficit budgetaire posait un probleme pressant au gouvernement provincial. Celui-ci decida de reduire le budget de la sante de 3,3% en 1992. L’annee suivante, le gouvernement mit en place une regionalisation des services de sante fondee sur la Loi sur les Districts de Sante, avec comme objectif de favoriser la prevention par rapport aux soins purement curatifs. 52 hopitaux ruraux durent fermer a cause des coupes budgetaires, entrainant une reaction de rejet de la part du public. Les evaluations de la reforme n’ont pas pu etablir avec certitude une deterioration de la sante dans les communautes concernees. Les habitants des communautes concernees ont exprime une charge accrue pour les aidants, des couts et temps de transports plus eleves pour se rendre a l’hopital le plus proche, et d’eventuelles inegalites d’acces aux soins. Les voix des populations concernees devraient etre ecoutees lors de la prise de decision sur de telles reformes.

Regionalization and the Closure of 52 Hospitals in Rural Saskatchewan