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Coordinating primary care services: A case of policy layering

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  • Rudoler, David
  • Peckham, Allie
  • Grudniewicz, Agnes
  • Marchildon, Greg

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.

Suggested Citation

  • Rudoler, David & Peckham, Allie & Grudniewicz, Agnes & Marchildon, Greg, 2019. "Coordinating primary care services: A case of policy layering," Health Policy, Elsevier, vol. 123(2), pages 215-221.
    • Handle: RePEc:eee:hepoli:v:123:y:2019:i:2:p:215-221
    DOI: 10.1016/j.healthpol.2018.12.002
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    References listed on IDEAS

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    1. David Rudoler & Raisa Deber & Janet Barnsley & Richard H. Glazier & Adrian Rohit Dass & Audrey Laporte, 2015. "Paying for Primary Care: The Factors Associated with Physician Self‐selection into Payment Models," Health Economics, John Wiley & Sons, Ltd., vol. 24(9), pages 1229-1242, September.
    2. Michael Howlett & Pablo del Rio, 2015. "The parameters of policy portfolios: verticality and horizontality in design spaces and their consequences for policy mix formulation," Environment and Planning C, , vol. 33(5), pages 1233-1245, October.
    3. Arthur Sweetman & Gioia Buckley, 2014. "Ontario's Experiment with Primary Care Reform," SPP Research Papers, The School of Public Policy, University of Calgary, vol. 7(11), April.
    4. Rudoler, David & Laporte, Audrey & Barnsley, Janet & Glazier, Richard H. & Deber, Raisa B., 2015. "Paying for primary care: A cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada," Social Science & Medicine, Elsevier, vol. 124(C), pages 18-28.
    5. Kathleen Thelen, 2009. "Institutional Change in Advanced Political Economies," British Journal of Industrial Relations, London School of Economics, vol. 47(3), pages 471-498, September.
    6. Michael Howlett, 2009. "Governance modes, policy regimes and operational plans: A multi-level nested model of policy instrument choice and policy design," Policy Sciences, Springer;Society of Policy Sciences, vol. 42(1), pages 73-89, February.
    7. Adam Wellstead & Jeremy Rayner & Michael Howlett, 2016. "Alberta's oil sands reclamation policy trajectory: the role of tense layering, policy stretching, and policy patching in long-term policy dynamics," Journal of Environmental Planning and Management, Taylor & Francis Journals, vol. 59(10), pages 1873-1890, October.
    8. Michael Howlett & Jeremy Rayner, 2013. "Patching vs Packaging in Policy Formulation: Assessing Policy Portfolio Design," Politics and Governance, Cogitatio Press, vol. 1(2), pages 170-182.
    9. Peckham, Allie & Morton-Chang, Frances & Williams, A. Paul & Miller, Fiona A., 2018. "Rebalancing health systems toward community-based care: The role of subsectoral politics," Health Policy, Elsevier, vol. 122(11), pages 1260-1265.
    10. Marchildon, Gregory P. & Hutchison, Brian, 2016. "Primary care in Ontario, Canada: New proposals after 15 years of reform," Health Policy, Elsevier, vol. 120(7), pages 732-738.
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    Cited by:

    1. McKay, Madeleine & Lavergne, M. Ruth & Lea, Amanda Prince & Le, Michael & Grudniewicz, Agnes & Blackie, Doug & Goldsmith, Laurie J. & Marshall, Emily Gard & Mathews, Maria & McCracken, Rita & McGrail,, 2022. "Government policies targeting primary care physician practice from 1998-2018 in three Canadian provinces: A jurisdictional scan," Health Policy, Elsevier, vol. 126(6), pages 565-575.
    2. Allin, Sara & Martin, Elisabeth & Rudoler, David & Church Carson, Michael & Grudniewicz, Agnes & Jopling, Sydney & Strumpf, Erin, 2021. "Comparing public policies impacting prescribing and medication management in primary care in two Canadian provinces," Health Policy, Elsevier, vol. 125(9), pages 1121-1130.

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