Coordinating primary care services: A case of policy layering

David Rudoler; Allie Peckham; Agnes Grudniewicz; Greg Marchildon

doi:10.1016/j.healthpol.2018.12.002

Coordinating primary care services: A case of policy layering

Health Policy. 2019 Feb;123(2):215-221. doi: 10.1016/j.healthpol.2018.12.002. Epub 2018 Dec 14.

Authors

David Rudoler¹, Allie Peckham², Agnes Grudniewicz³, Greg Marchildon²

Affiliations

¹ Faculty of Health Sciences, University of Ontario Institute of Technology, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. Electronic address: [email protected].
² Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; North American Observatory on Health Systems and Policies, Canada.
³ Telfer School of Management, University of Ottawa, Canada; Institut du-savoir Montfort, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.

PMID: 30583803
DOI: 10.1016/j.healthpol.2018.12.002

Abstract

In this paper, we discuss the processes of policy layering as they relate to health care reform. We focus on efforts to achieve systems of coordinated primary care, and demonstrate that material change can be achieved through processes of incremental policy layering. Such processes also have a high potential for unintended consequences. Thus, we propose new principles of 'smart' policy layering to guide decision-makers to do incrementalism better. We then apply these principles to recent primary care reforms in Ontario, Canada. This paper conceptualizes 'smart' policy layering as a mechanism to achieve productive policy change in contexts with strong institutional barriers to reform.

Keywords: Care coordination; Policy change; Policy layering; Policy reform; Primary care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Decision Making, Organizational
Delivery of Health Care / organization & administration
Health Care Reform
Health Policy*
Humans
Ontario
Primary Health Care / organization & administration*