Health reform in Alberta: The introduction of health regions

Abstract: In 1994, the Government of Alberta passed the Regional Health Authorities Act to abolish nearly 200 existing local hospital and public health boards and replace them with seventeen regional health authorities. Consistent with the larger fiscal agenda, the government's intention was to address health‐care system efficiency through larger integrated management and governance structures. In this article, the authors examine why Alberta decided to create regional health authorities for the management and delivery of a significant range of health services. In examining the interaction of ideas, interests and institutions, the authors conclude that the government was partially successful in aligning existing institutional and interest relationships with an emerging political consensus about cost and sustainability of the health‐care system. Sommaire: En 1994, le gouvernement de l'Alberta a adopté la loi intitulée Regional Health Authorities Act (Loi sur les offices régionaux de santé) en vue d'abolir près de 200 commissions hospitalières et commissions de santé publique locales et de les remplacer par dix‐sept offices régionaux de la santé. Conformément au programme fiscal plus large, l'intention du gouvernement était d'examiner l'efficience du système des soins de santé grâce à des structures intégrées de gestion et de gouvernance plus vastes. Dans le présent article, les auteurs examinent les raisons pour lesquelles l'Alberta a décidé de créer des offices régionaux de la santé pour la gestion et la prestation d'une gamme importante de services de santé. Après avoir étudié les interactions d'idées, d'intérêts et d'institutions, les auteurs ont conclu que le gouvernement avait partiellement réussi à aligner les relations institutionnelles et les relations d'intérêts existantes sur un consensus politique émergent au sujet des coûts et de la viabilité du système de soins de santé.     

G.W.F. Hegel on Self‐Determination and Democratic Theory

This article claims that the major alternative models of contemporary democratic theory—the aggregative, deliberative, and agonistic models—are grounded on a norm of self‐determination, but each conceptualizes this self‐determination in a different, and one‐sidedly narrow, way. G.W.F. Hegel provides a conceptual scheme in which to understand the development and synthesize the insights of these three articulations of self‐determination. He also argues that the political embodiment of a complete self‐determination must be founded on economic self‐interest, though a self‐interest expanded to a concern for the common good through the experience of self‐government in one's economic and political associations. Thus, rather than separating economic and political spheres, as contemporary democratic theorists do, Hegel makes a case that modern self‐determination requires a structural harmony between these spheres.