Concept: Regional Health Authorities (RHA) in Manitoba

Introduction

In Manitoba, a Regional Health Authority (RHA) is a regional governance structure set up by the provincial government to be responsible for the delivery and administration of health services in a specific geographical area. This structure was implemented across Manitoba in 1997 and continues today.

This concept contains: information on the history and changes in Manitoba RHAs over time; a brief description of the method of assigning individuals to RHAs; information on the SAS code developed at MCHP for working with RHA geographical boundaries and assigning RHAs to the data for use in analyses; links to information in three different MCHP Deliverables focusing on RHA-specific information (e.g. health indicators); and links to additional resources/files for working with RHAs.

History and Changes in Manitoba RHAs

In 1997, the RHA structure was established in Manitoba with 13 RHAs. This consisted of two authorities in Winnipeg (the Winnipeg Community and Long Term Care Authority and the Winnipeg Hospital Authority) and 11 rural and northern RHAs: South Eastman, South Westman, Brandon, Central, Marquette, Parkland, North Eastman, Interlake, Burntwood, NOR-MAN and Churchill.

Over time, significant changes in the RHA structure in Manitoba include:


• In February 2000, the Winnipeg Regional Health Authority (WRHA) was formed through an amalgamation of the Winnipeg Community and Long Term Care Authority and the Winnipeg Hospital Authority.
  
  
• On July 1st, 2002 the Marquette and South Westman RHAs amalgamated to form the Assiniboine RHA.
  
  
• From July 2002 to May 30, 2012, the following 11 RHAs were responsible for the delivery and administration of health services in Manitoba:
  
  
  • Winnipeg,
    
  • Brandon,
    
  • South Eastman,
    
  • Assiniboine,
    
  • Central,
    
  • Parkland,
    
  • North Eastman,
    
  • Interlake,
    
  • Burntwood,
    
  • NOR-MAN, and
    
  • Churchill.
    
    A map illustrating the location and boundaries of these 11 RHAs is available: Map of Manitoba's 11 RHAs - 2004
  
  
• On May 30, 2012, the existing 11 RHAs were amalgamated into five larger regions. The new RHAs are listed below, with the old RHAs listed in brackets:
  
  
  • Winnipeg (Winnipeg, Churchill),
    
  • Interlake-Eastern (Interlake, North Eastman),
    
  • Prairie Mountain (Assiniboine, Brandon, Parkland),
    
  • Southern (Central, South Eastman), and
    
  • Northern (Burntwood, NOR-MAN).
    
    Source: Canadian Legal Information Institute. Amalgamation of Regional Health Authorities Regulation, 2012. C.C.S.M. c. R34. 2012.
    
    A map illustrating the location and boundaries of the five RHAs is available: Map of Manitoba's 5 RHAs - 2013

For current information on RHAs from Manitoba Health, please see the Manitoba Health - Regional Health Authorities in Manitoba Web Site.

RHA Districts and Zones

Each RHA is divided into smaller geographic areas called Districts and Zones, based on the requirements of the RHA. RHA Districts are the smallest areas related to RHAs and have changed over time. Detailed information on RHA Districts is available through the Regional Health Authority (RHA) Districts and Zones in Manitoba concept.

With the change from 11 to five RHAs in 2012, RHA Zones were created for each RHA outside of Winnipeg. Zones typically cover larger geographic areas (e.g.: North West, South and East) within an RHA, and are made up of several Districts.

For a listing of the RHA Districts and Zones in the new RHA structure, please see Appendix 1: Administrative Area Boundaries in The 2013 RHA Indicators Atlas deliverable.

Method of Assigning RHAs

Individuals are generally assigned to an RHA based on the municipal code assigned by Manitoba Health. The municipal code assigned to Treaty Status Indians always refers to their band of reserve association. Postal code is used to assign the RHA for these individuals using the following method:


• If the postal code matches the municipal code or the A-code of the reserve, then assign the resident to the existing municipal code of the corresponding RHA.
  
• If the municipal code and the postal code do not match, then allocate the resident to the municipal code associated with the postal code. A postal code to municipal code conversion file is obtained from Manitoba Health once a year in order to use the appropriate municipal codes.
  
• Allocate the resident to the RHA according to this municipal code.

MCHP / Manitoba Health Codes for RHAs

MCHP and Manitoba Health use different codes for RHAs. This difference dates back to a time when the RHA boundaries were first being developed but were not yet defined as part of Manitoba Health (MB Health) data. MCHP uses alphabetic codes; MB Health uses numeric codes. This difference allows users to identify the source of the values when working with new or unfamiliar data.

Currently MCHP, again because of an old system, codes Winnipeg with three codes (H, I, J). Users should always combine this into a single code (K).

Table 1: Codes used by MCHP and MB Health to Define 11 RHAs in Manitoba



MCHP	MB Health	RHA Name
A	40	A-40 CENTRAL
BS	25	BS-25 SOUTH EASTMAN
BN	20	BN-20 NORTH EASTMAN
C	30	C-30 INTERLAKE
D	70	D-70 NOR-MAN
E	60	E-60 PARKLAND
FC	90	FC-90 CHURCHILL
FB	80	FB-80 BURNTWOOD
GA	45	GA-45 ASSINIBIOINE (Formed July 1, 2002 from South Westman and Marquette) *
G	15	G-15 BRANDON
K	10	K-10 WPG **

NOTES:



*	GS	55	GS-55 SOUTH WESTMAN (Joined with Marquette July 1, 2002)
*	GM	50	GM-50 MARQUETTE (Joined with S. Westman July 1, 2002)
**	H	H-10	WPG-WEST CENTRAL (not used)
**	I	I-10	WPG-NORTH (not used)
**	J	J-10	WPG-SOUTH (not used)

SAS Macros, Formats and Labels

RHA related SAS macros, formats and labels are available for defining and labelling the RHAs over time. All of the relevant files are located in either the system macro library or the system format library. Use the following guidelines:


• use the _rha12.sas macro and the rha12f format if you are using the "new" 5 RHAs structure;
  
• use the _rha05.sas macro and the rhaf format if you are using the "old" 11 RHAs structure; and
  
• use the _pre97adj.sas macro if you are using data prior to 1997; this makes appropriate adjustments. If using data before 1989 the fit is only approximate.
  
• use rhal for labelling all the RHA definitions.
  
  NOTES:
  
  • The digits in the SAS® macro and format names refer to the relevant year of development, not the number of RHAs.
    
  • For more information, please see the November 15, 2012 Data Analyst Meeting Minutes available in the LINKS section (internal access only) below.
    
  • Please see the SAS Code and Formats section (internal access only) below for example SAS code relating to the RHAs.

RHA Information in MCHP Deliverables

Many MCHP Deliverables provide information on indicators of population health status, healthcare use and quality of care at the RHA level. This information is intended to assist RHAs in planning and administration of the health services and resources available in their area. The following three MCHP deliverables focus specifically on RHA content:


• The Manitoba RHA Indicators Atlas by Martens et al. (2003)
  
• Manitoba RHA Indicators Atlas 2009 by Fransoo et al. (2009)
  
• The 2013 RHA Indicators Atlas by Fransoo et al. (2013)

The Manitoba RHA Indicators Atlas - (2003)

This report focuses on the non-Winnipeg RHAs; therefore Winnipeg is not included as one of the RHAs, except as a comparison at the bottom of selected graphs. Analyses for this project was completed prior to the amalgamation of South Westman and Marquette into the Assiniboine RHA, thus indicators are reported for 11 non-Winnipeg RHAs and their respective Districts. The following links are provided for easier access to information in this report:


• Map of the Regional Health Authorities (RHAs) of Manitoba;
  
• How the Regions and Subregions are Defined and Displayed;
  
• Table of Contents - provides a starting point to see what information is available in the deliverable; and
  
• Data Extras - contains profile summary information of key indicators for RHA and RHA Districts, including demographic information, health status and mortality, illness burden, preventive services, child health, physician data, hospital data, high profile and discretionary procedures, home care and Personal Care Home (PCH) data, and pharmaceutical data.

Manitoba RHA Indicators Atlas 2009 - (2009)

This report provides data for all 11 RHAs in Manitoba, including Winnipeg, as well as the sub-areas within them. Non-Winnipeg RHA sub-areas are called Districts. Winnipeg has two levels of sub-areas: 12 Community Areas, which further sub-divide into 25 Neighbourhood Clusters. The following links are provided for easier access to information in this report:


• Map of the Regional Health Authorities (RHAs) of Manitoba;
  
• Geographical Boundaries in This Report;
  
• Table of Contents - provides a starting point to see what information is available in the deliverable; and
  
• Data Extras - contains additional figures and tables on demographics, population health status and mortality, burden of physical illness, mental illness, physician services, hospital services, high profile surgical and diagnostic services, home care services, Personal Care Homes (PCH), preventive and other services, prescription drug use, quality of primary care, and results from the Canadian Community Health Survey (CCHS).

The 2013 RHA Indicators Atlas - (2013)

This report provides data for the five new Health Regions as well as the 11 former Regional health Authorities in Manitoba. For most indicators, there are "district-level" and "zone-level" analyses as well. The following links are provided for easier access to information in this report:


• Map of Manitoba Health Regions and Former Regional Health Authorities;
  
• Geographical Boundaries Used in This Report;
  
• Table of Contents - provides a starting point to see what information is available in the deliverable; and
  
• Data Extras - contains supplemental figures and tables that were not printed in the report as well as additional material that can be downloaded. These files include information about changes in indicators of mortality and indicators of diseases and health conditions; maps of RHAs, RHA Districts and RHA Zones; and indicators on demographics, mortality, physical illness, mental illness, physician services, hospital services, surgical and diagnostic services, Personal care Homes (PCH), preventive and other services, and quality of primary care.

Additional Resources/Files

Additional Resources for RHAs


• Map of 11 RHAs - 2004 (pdf format)
  
• Map of 11 RHAs - 2004 (jpg format)
  
• RHA ArcView Shape file - 2006 (.zip format)
  
• Map of 5 RHAs - 2013 (pdf format) - downloaded from Manitoba Health web site on December 4, 2013.

Additional Resources for RHA Districts


• Map of RHA Districts - 2004 (pdf format)
  
• Map of RHA Districts - 2004 (jpg format)
  
• RHA Districts ArcView Shape file - 2004 (.zip format)
  
• RHA Districts ArcView Shape file - 2006 (.zip format)

Cautions / Limitations

• Some of the datasets in the MCHP Data Repository contain variables collected by Manitoba Health that are related to RHAs or Regions in Manitoba (e.g. RHAMUN in the Hospital Discharge Abstracts 1997 APR dataset; REGION in the Management Information System (MIS) dataset). It is highly recommended that MCHP use the RHA macro, format and label files developed by MCHP for any RHA level analyses because the "Manitoba Health" data can be quite different than the RHA data at MCHP.