What's past is prologue: A historical-institutionalist analysis of public-private change in Ontario's rehabilitation health sector, 1985--1999.

摘要

The dissertation addresses the privatization of rehabilitation services in Ontario over a 15-year period during which three ideologically distinct administrations held office in the province: the Peterson Liberals (1985–1990); the Rae NDP (1990–1995); and the Harris Conservatives (1995–1999). Its chief questions are: How is it that a clear, rapid, and virtually uncontested trajectory of privatization developed in a Canadian health care sector across three such ideologically distinct administrations? And what are the features of this privatization?; To address the first question, the author employs a historical-institutionalist conceptual framework to analyze the trajectory of policy change that occurred. She compares policy changes occurring over the course of the three administrations in the three ministries, and their corresponding communities, at whose intersection rehabilitation policy is set: the Ministry of Health, for public health care insurance; the Ministry of Finance, for automobile casualty insurance; and the Ministry of Labour, for workplace injury insurance.; With respect to the second question, she uses the Stoddart and Labelle (1985) framework of five axes of privatization (financing, management, administration, regulation, and ownership) to analyze changes in the public-private boundary for rehabilitation services. And she proposes the addition of a sixth axis: political privatization.; She draws her data almost exclusively from extensive documentation that exists in the public record, and analyzes it in accordance with these two frameworks.; Theoretically, the thesis is concerned with state retrenchment in public-policy arenas (the three insurance areas). The author concludes that the institutional organization of policy making in the rehabilitation health sector—in particular, its fragmentation—was a key factor in the trajectory of privatization that developed. She suggests that institutional organization of policy arenas may be a factor more generally in where and how retrenchment occurs. And she suggests a concept of “ricochet effects” to describe the unanticipated interaction effects in a policy arena characterized by such organizational fragmentation.