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Health care reform in British Columbia : dynamics without change? Davidson, Alan Reginald

Abstract

The case study examines impacts on the exercise of power and the allocation of resources in health care delivery in British Columbia stemming from provincial policies of regionalization and devolution. The study examines the policy implementation process from 1993 to 1999, with the emphasis falling on the policy controversy provoked by the New Directions reform (1993 to 1996). The study also contributes to theory development regarding the policy implementation process by expounding and applying an approach to policy-as-ideology. Another subsidiary purpose is to contribute to theory regarding the power and accountability of health care providers and lay members of health services' governance structures. The study demonstrates the persistence of structural power relations within the health care sector. It concludes that the health reform initiative failed to impose controls over health care professionals and providers, failed to improve accountability of programmes to the public, failed to affect a reallocation of resources in the health sector, and failed to shift the policy perspective from the delivery of health care services to a community health perspective. The reorganization that was achieved through the reform did, however, strengthen administrative arrangements and improve technical efficiency.

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