1. How do Policy and Institutional Settings Shape Opportunities for Community-Based Primary Health Care? A Comparison of Ontario, Québec and New Zealand
- Author
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Frances Morton-Chang, Fiona A. Miller, Mylaine Breton, Walter P. Wodchis, Toni Ashton, Tim Tenbensel, Alexandra Peckham, Nicolette Sheridan, Timothy Kenealy, A. Paul Williams, and Yves Couturier
- Subjects
Canada ,Economic growth ,Health (social science) ,Sociology and Political Science ,Policy Paper ,Population ,Primary health care ,Population health ,Space (commercial competition) ,03 medical and health sciences ,0302 clinical medicine ,community-based primary health care ,New Zealand ,policy ,institutions ,Relevance (law) ,030212 general & internal medicine ,education ,Health policy ,Fence (finance) ,Community based ,lcsh:R5-920 ,education.field_of_study ,030503 health policy & services ,Health Policy ,health policy, health services research, primary care ,3. Good health ,Business ,lcsh:Medicine (General) ,0305 other medical science - Abstract
Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health care have stimulated local initiatives and influenced the design of policy solutions. However, the ways in which these ideas and influences find their way into policy and practice is strongly mediated by policy settings and institutional legacies of particular jurisdictions. This paper seeks to compare the key institutional and policy features of Ontario, Québec and New Zealand that shape the ‘space available’ for models of community-based primary health care to take root and develop. Our analysis suggests that two key conditions are the integration of relevant health and social sector organisations, and the range of policy levers that are available and used by governments. New Zealand has the most favourable conditions, and Ontario the least favourable. All jurisdictions, however, share a crucial barrier, namely the ‘barbed-wire fence’ that separates funding of medical and ‘non-medical’ primary care services, and the clear interests primary care doctors have in maintaining this fence. Moves in the direction of system-wide community-based primary health care require a gradual dismantling of this fence.
- Published
- 2017