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

from Health Policy at on September 29, 2018 at 04:48PM

Publication date: Available online 28 September 2018

Source: Health Policy

Author(s): Allie Peckham, Frances Morton-Chang, A. Paul Williams, Fiona A. Miller


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.

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