We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Health-care reform and the dimensions of professional autonomy.
- Authors
Randall, Glen E.; Williams, A. Paul
- Abstract
A “managed competition” model was introduced in the Canadian province of Ontario as part of the government's reform of home care. With this model, it was assumed that competitive forces would encourage quality while driving down costs. While such reforms often achieve cost controls by constraining the incomes and practices of health-care workers, there has been relatively little analysis of the extent to which self-governing health-care professionals, particularly those outside of medicine and nursing, may experience a decline in their ability to control the content and context of their professional work. In this article, the authors analyse the results of thirty-six in-depth interviews with representatives of Community Care Access Centres (CCACs), the organizations that purchase and coordinate the delivery of home-care services, and rehabilitation provider agencies to examine the impact of Ontario's managed competition reform on rehabilitation professionals. Findings suggest that the impact of the reform varied across the economic, political, and clinical dimensions of professional autonomy and that, despite a general loss of autonomy under the managed competition model, market forces also served to mitigate the loss of autonomy, thus contributing to a remarkable resilience of professional autonomy.
- Subjects
CANADA; HEALTH care reform; MANAGED care programs; MEDICALLY underserved areas; REGIONAL medical programs; MEDICAL care cost control; HEALTH policy; GOVERNMENT policy
- Publication
Canadian Public Administration, 2009, Vol 52, Issue 1, p51
- ISSN
0008-4840
- Publication type
Article
- DOI
10.1111/j.1754-7121.2009.00059.x