Over the past four decades, the most significant organizational change has been the establishment of health authorities that have been delegated by provincial governments to manage health systems. The continual changes made to the structure of health authorities, including the recent trend to more centralized administration, have caused considerable upheaval. Although a major change in the immediate future would only amplify this upheaval, it is still worth delegating to health authorities the additional responsibility for the payment and management of health human resources, including physician remuneration and bargaining. This is one more incremental change that holds the greatest promise in terms of improving accountability and health system performance.

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