How do policy and institutional settings shape opportunities for community-based primary health care? A comparison of Ontario, Québec and New Zealand

Tim Tenbensel, Fiona Miller, Mylaine Breton, Yves Couturier, Frances Morton-Chang, Toni Ashton, Nicolette Sheridan, Alexandra Peckham, A. Paul Williams, Tim Kenealy, Walter Wodchis

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

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.

Original languageEnglish (US)
Article number13
JournalInternational Journal of Integrated Care
Volume17
Issue number2
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

Keywords

  • Canada
  • Community-based primary health care
  • Institutions
  • New Zealand
  • Policy

ASJC Scopus subject areas

  • Health(social science)
  • Sociology and Political Science
  • Health Policy

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