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Rebalancing health systems toward community-based care: The role of subsectoral politics

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  • Peckham, Allie
  • Morton-Chang, Frances
  • Williams, A. Paul
  • Miller, Fiona A.

Abstract

There has been increased policy discourse urging a “rebalancing” of health systems from institutionally-based to community-based approaches. This paper offers an analysis of the subsectoral dynamics that condition opportunities to strengthen community-based care relative to acute care. We report on the results of a policy study in Ontario, Canada that explored factors impacting on the capacity to expand community-based care. In so doing, we highlight the challenges associated with the community subsector’s ability to develop ‘critical’ status and challenge the dominance of the acute subsector. We conclude that attempts to rebalance health systems toward community-based care should begin by understanding that health care is not a monolithic policy sector, but rather a collection of proximate policy sub-sectors, inclusive of community care, acute care, and institutional care, each with their own internal characteristics and dynamics that impact sectoral directions.

Suggested Citation

  • Peckham, Allie & Morton-Chang, Frances & Williams, A. Paul & Miller, Fiona A., 2018. "Rebalancing health systems toward community-based care: The role of subsectoral politics," Health Policy, Elsevier, vol. 122(11), pages 1260-1265.
    • Handle: RePEc:eee:hepoli:v:122:y:2018:i:11:p:1260-1265
    DOI: 10.1016/j.healthpol.2018.09.014
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    References listed on IDEAS

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    1. David Rudoler & Raisa Deber & Janet Barnsley & Richard H. Glazier & Adrian Rohit Dass & Audrey Laporte, 2015. "Paying for Primary Care: The Factors Associated with Physician Self‐selection into Payment Models," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1229-1242, September.
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    5. Rayner, Jeremy & Howlett, Michael & Wilson, Jeremy & Cashore, Benjamin & Hoberg, George, 2001. "Privileging the sub-sector: critical sub-sectors and sectoral relationships in forest policy-making," Forest Policy and Economics, Elsevier, vol. 2(3-4), pages 319-332, July.
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    Cited by:

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    2. Sunwei Liu & Yupeng Wang & Dian Zhou & Yitong Kang, 2020. "Two-Step Floating Catchment Area Model-Based Evaluation of Community Care Facilities’ Spatial Accessibility in Xi’an, China," IJERPH, MDPI, vol. 17(14), pages 1-17, July.
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    4. Rudoler, David & Peckham, Allie & Grudniewicz, Agnes & Marchildon, Greg, 2019. "Coordinating primary care services: A case of policy layering," Health Policy, Elsevier, vol. 123(2), pages 215-221.

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