Policy by default
Subtitle: how changes in Ontario's home care sector have impacted providers, children and families.
Published: 2005
Language: eng
Number of pages: 251
Description: There are three main findings from this study. First, in the Ontario home care sector between 1997--2002, faced with increasing demands for, and costs of, home care services, the CCACs responded by "load shedding". Over the five years of the study, care that was once publicly funded through, either former home care programs or the CCACs, technically became effectively "de-insured". This meant that family members were expected to provide care themselves (directly, or by purchasing services out-of-pocket, or through third party payers) or find other government ministries, schools, community and social services that would provide similar services.In all developed countries in the past decade there has been a substantial increase in emphasis on the delivery of care on an ambulatory basis and a concomitant growth in the provision of home care services. In Canada, this shift of care from hospitals and institutions to homes and communities has been driven by major health system restructuring initiatives, technological advances, and changing social values. However, this shift from hospital to home results in more than just a shift in the "site" of care; for the reasons elaborated in this thesis, it has much broader implications for the funding, allocation, and delivery of home and community care services.This thesis analyses key policy decisions regarding the funding, allocation, and delivery of home and community services to children in Ontario between 1997 and 2002. In particular, the implications of these policy decisions for pediatric providers, children requiring home and community care, and their families, are examined. The research comprised an in-depth, case-study analysis of Ontario's Community Care Access Centres (CCACs), using key informant interviews with CCAC directors, as well as focus groups with CCAC case managers, consumers (parents), and managers of pediatric home care provider organizations.Third, the study demonstrates the significant limitations of managed competition models for delivery of specialized services when there is no surplus capacity in the system. (Abstract shortened by UMI.)Second, the decision about the type and amount of services to be publicly funded by the CCACs was devolved to case managers. In the absence of standardized central policy, the case managers act like 'street level bureaucrats' (Lipsky, 1980), since they have discretionary power to not only implement government policy but in effect to make policy by default, through a series of idiosyncratic allocation decisions. Therefore, access to publicly funded services can vary significantly depending on where children live in the province, which is not in line with the intent of the Canada Health Act.
Notes: Thesis (Ph.D.)--University of Toronto, 2005.

Electronic version licensed for access by U. of T. users.

Source: Dissertation Abstracts International, Volume: 66-06, Section: B, page: 3038.