Beyond "financial incentives": how stakeholders interpret Ontario's funding structure for midwifery
Article Abstract:
The 1994 introduction of midwifery as a publicly paid service in Ontario created new incentives in the health-care system. Traditional economic models of financial incentives explain stakeholder responses in terms of the pursuit of financial gains and avoidance of financial losses. To explore and explain more social and political responses by stakeholders, we conducted a qualitative case study. We applied an alternative model of financial incentives to analyse funding arrangements as policy messages and to investigate how stakeholders interpret them. Interpretations of the midwifery funding structure follow three broad themes. First, payment structures make a policy statement about the legitimacy and autonomy of the midwifery profession and its status relative to other professions such as medicine and nursing. Second, funding mechanisms imply how midwifery's services will fit in with other health services (specifically, substituting for, adding to, or competing with traditional obstetrics). Finally, stakeholders caricaturize midwifery clients to illustrate whether public funding creates more or less equitable access to care. Ontario's experience with midwifery offers insights for understanding the social dimensions of financial incentives, as well as for anticipating issues that arise when using funding policies as instruments of health-care reform. (Reprinted by permission of the publisher.)
Publication Name: Canadian Public Administration
Subject: Government
ISSN: 0008-4840
Year: 1998
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Organizational design and precarious values: the rise and fall of Ontario's Ministry of Skills Development
Article Abstract:
In 1985 the Ontario government created the Ministry of Skills Development to coordinate provincial training and labour-market adjustment policy. The organization's design and inception were inadequate in several respects and failed to acknowledge the fragmented jurisdiction and precarious values of this policy area. Consequently, the organization faced turmoil from birth: three ministers in six months; an uncertain mandate, which was never confirmed in statute; multiple clients, which were contested by other ministries; a corporate culture, which caused a dysfunctional schism between the policy and operations groups; and inappropriate leadership. In 1989, this ministry was severely truncated and then eliminated altogether in 1993. Six lessons emerge from the ministry's collapse. They recognize the need to alter the policy field rather than merely reshuffling boxes, the importance of allowing a new organization time to coalesce, how the new bureau will be received by existing organizations, the critical role of leadership in addressing deficits in prestige and legitimacy, the need for ongoing support from the centre, and the need to understand and heed the examples of history. These lessons are particularly salient as governments increasingly reorganize and restructure. (Reprinted by permission of the publisher.)
Publication Name: Canadian Public Administration
Subject: Government
ISSN: 0008-4840
Year: 1996
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