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11 Regional Health Boards (RHBs) and 34 Community Health Councils (CHCs) were established in BC on April 1, 1997. These health authorities are responsible for the funding and governance of acute, long-term, and community-based health services and, collectively, allocate more than half of the BC health budget (more than $4.5 billion of a total $8.1 billion).

The ongoing lack of effective public and professional input into regional health care decision-making is of considerable concern. For example, although RHBs/CHCs have been in place for more than 3 years, at time of publication 6 of BC’s health authorities still do not have functioning Regional Medical Advisory Committees (RMACs). Many RMACs have only recently been struck and there remain significant concerns regarding composition and the lack of a direct reporting relationship to the health board. Prior to regional governance, all BC hospitals had functioning Medical Advisory Committees that reported directly to the Board. This marks a significant loss of practising physician input into quality of care and policy decisions at the local level. The RMAC is a critical source of input into regional decision-making and, to be effective, must include a direct presence at the Board level. Experience in other jurisdictions has shown that, unless effective practising physician input is obtained, local health care governance cannot succeed.