Coordinating primary care services: A case of policy layering. Issue 2 (February 2019)

• Record Type: Journal Article
• Authors: Rudoler, David; Peckham, Allie; Grudniewicz, Agnes; Marchildon, Greg
• Is Part Of: Health policy. Volume 123:Issue 2(2019)
• Page Start: 215
• Page End: 221
• Publication Date: 2019-02
• Subjects: Policy change -- Policy reform -- Policy layering -- Primary care -- Care coordination; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2018.12.002
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Policy change can occur through processes of incremental policy layering. Policy layering can result in unintended consequences. We propose principles of 'smart layering' to guide decision-makers. This approach is applied to reform of primary health care systems. 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.