The impact of restructuring on acute care hospitals in Newfoundland

John’s, the largest of the province’s acute care boards, implemented program-based management, partly to facilitate the closure of a hospital and the integration of clinical services. [...] Information on the history of regionalization and restructuring in the province from the late 1980s to 2002 was collected and analysed. [...] The primary purpose is to inform policy makers and stakeholders, including consumers, about the impact of regionalization of responsibility for care delivery, programmatic management in the acute care setting, and closure of hospitals. [...] We collected information on: 1) the history of regionalization and restructuring in the province from the late 1980s to 2002; 2) changes in costs of acute care delivery; 3) acuity and use; 4) efficiency of acute care bed use; 5) access to select healthcare services; 6) human resource indicators; 7) healthcare provider perceptions of restructuring, the workplace, and quality of care; 8) quality of [...] A review of this region, reported in October 2001, suggested that problems related to: conflicting messages and lack of funding on the part of the province; failure of the regional board to deal with inappropriate provincial and municipal interference; the lack of buy-in to a regional model by region physicians; and politicians fostering their own agendas using the healthcare system.