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Shifting Sands

Shifting Sands: Government-Group Relationships in the Health Care Sector

Copyright Date: 1994
Pages: 240
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  • Book Info
    Shifting Sands
    Book Description:

    During the 1970s and 1980s policymaking in the complex area of regulatory legislation of the health disciplines became both increasingly important and increasingly difficult for the Canadian provinces. In this comparative study Joan Boase traces the evolution of relationships among governments and health care interest groups in four provinces - Ontario, Quebec, Nova Scotia, and Alberta - and finds that, although they have faced similar problems, they have responded in different ways.

    eISBN: 978-0-7735-6451-0
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. List of Tables and Charts
    (pp. xi-xii)
  4. Abbreviations
    (pp. xiii-xiv)
  5. Preface
    (pp. xv-xvi)
  6. Acknowledgments
    (pp. xvii-xviii)
  7. Introduction
    (pp. xix-xxvi)

    The Thorburn quote above captures much of the essence of the changing health care sector, and underlines its increasingly troublesome nature. The disciplines involved, composed of semi-autonomous professionals and paraprofessionals, absorb a substantial proportion of health care funds,¹ yet their relationships with governments and among themselves have remained largely unexplored. Although these groups are all self-regulating to some degree, provincial legislation determines the manner in which they provide services to the public, and the manner in which they are remunerated. Historically, this is an area that has been dominated by an elite group—the medical profession—which is now competing...


    • Chapter One The Nature of the Health Care Policy Community
      (pp. 3-20)

      Most of the literature of government-group relationships in the health policy field proceeds on the assumption that the dominance of the medical profession in this sector virtually excludes other interests from exerting influence on government decision-making.¹ That is, relevant interest group studies tend to focus on the high-profile relationships between the medical associations and health ministries to explain the nature of policy making.² This was a legitimate approach prior to the adoption of medicare in 1966, but it increasingly offers only a partial explanation of the complexities of policy development in the regulation of health disciplines. It is the thesis...

    • Chapter Two Group-State Traditions and Policy Networks
      (pp. 21-36)

      The previous chapter discussed many of the characteristics particular to the professional groups in the health care sector and the usefulness of the policy community/policy network models to explicate their interactions with governments. These models are more inclusive and therefore more explanatory than previous society-based theories of interest group activity, because the conception of the policy community includes the state representatives that interact with that community. The idea of network also brings the state in, since the networks that develop are the result of interactions within the community. However, Atkinson and Coleman, noting the deficiencies of the policy community/policy network...


    • Chapter Three The Evolving Environmental Background
      (pp. 39-62)

      In 1978, Michael Trebilcock correctly predicted future governmentprofessional relationships when he said, “We may anticipate continuing, and indeed heightened, controversies over the regulation of the professions as they continue to evolve into one of our most important economic sectors.”¹ However, since health care is publicly financed, the controversies over the regulation of the health disciplines are qualitatively different from those over the regulation of other professionals. Since hospital care and medical care were introduced as costsharing insurance plans in the late 1950s and 1960s respectively, health economics, intergovernmental relations, and the regulation of the health disciplines have been inextricably linked....

    • Chapter Four First Steps Toward Anticipatory Policy Making
      (pp. 63-89)

      Royal commissions and task forces have several important roles to play in Canadian politics. First, as in-depth studies of a particular sector of society, they can provide governments with crucial background information and recommendations to aid in future policy making. Second, significant and useful research studies are often published in conjunction with these reports, providing valuable analyses and reference works. Third, royal commissions and task forces help to raise public awareness about a certain sector as they focus attention on a policy area the government (or sometimes the public) has identified as important or problematical. Closely related to the third...

    • Chapter Five A Policy Community in Action
      (pp. 90-112)

      The previous chapter examined some of the studies commissioned by the provincial governments in their attempts to understand and to organize public policy in a quickly evolving and crucial field. Two themes pervaded these reports; first, they documented a clear lack of coordination and cooperation and a thoroughly entrenched competitiveness among the various groups. More than once, the health care community was described as chaotic. The second theme was the common recommendation that the required degree of planning would necessitate increased government control and intervention. Few groups received this recommendation favourably because, long accustomed to rather flexible scopes of practice...


    • Chapter Six Culture, Institutions, and Traditions
      (pp. 115-133)

      The object of this chapter is to suggest how historical traditions, both cultural and institutional, have led to different, although slowly converging health services policy responses in these provinces. The discussion in chapter 2 focused on the characteristics of states at the macro level and the relationships between these characteristics and the types of policy networks that could be expected to evolve. The chapter concluded that in the health care sector in the Canadian state there was evidence of a strong interventionist state and a potential for increasingly independent state action. This chapter will suggest that when analysis is brought...

    • Chapter Seven The Ontario Review
      (pp. 134-164)

      The previous chapters have traced the many stresses on governments which have led to evolution in government-group relationships since the introduction of medical care in 1966. It is evident that the immediate shift from a laissez-faire system to a redistributive system implicit in the adoption of the Medical Care Act was not accompanied by an immediate shift in government-group relationships, but that the shift precipitated a slow and inexorable progression toward increasing government control. The health services groups are essential to a wellfunctioning national health insurance plan, and a long-term rationalization of this sector depends upon the expectation of cooperation...

    • Chapter Eight Slowly Shifting Sands
      (pp. 165-176)

      Tracing the evolution of relationships among governments and health care interest groups in the Canadian provinces selected for this study gives rise to three significant observations. First, there has been an apparent shift, particularly evident in the actions of the governments of the two large provinces, from a dependence on interest group liberalism toward concerted efforts to plan the structure of the health care system. This move has coincided with the development of national health insurance. Second, as the system of interest intermediation evolved, it became apparent that the policy networks which developed differed from province to province. These disparate...


    • Appendix A Questionnaire to Selected Health Disciplines in Ontario
      (pp. 177-178)
    • Appendix B Questionnaire to Selected Health Disciplines in Alberta and nova Scotia
      (pp. 179-179)
    • Appendix C Questionnaire after HPLR Submission of Proposed Legislation
      (pp. 180-180)
  12. Notes
    (pp. 181-208)
  13. Index
    (pp. 209-213)