Centre for Rural and Northern Health Research and Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada.
Hum Resour Health. 2008 Nov 11;6:24. doi: 10.1186/1478-4491-6-24.
Shortages and maldistribution of physicians in northern Ontario, Canada, have been a long-standing issue. This study seeks to document, in a chronological manner, the introduction of programmes intended to help solve the problem by the provincial government over a 35-year period and to examine several aspects of policy implementation, using these programmes as a case study.
A programme analysis approach was adopted to examine each of a broad range of programmes to determine its year of introduction, strategic category, complexity, time frame, and expected outcome. A chronology of programme initiation was constructed, on the basis of which an analysis was done to examine changes in strategies used by the provincial government from 1969 to 2004.
Many programmes were introduced during the study period, which could be grouped into nine strategic categories. The range of policy instruments used became broader in later years. But conspicuous by their absence were programmes of a directive nature. Programmes introduced in more recent years tended to be more complex and were more likely to have a longer time perspective and pay more attention to physician retention. The study also discusses the choice of policy instruments and use of multiple strategies.
The findings suggest that an examination of a policy is incomplete if implementation has not been taken into consideration. The study has revealed a process of trial-and-error experimentation and an accumulation of past experience. The study sheds light on the intricate relationships between policy, policy implementation and use of policy instruments and programmes.
加拿大安大略省北部长期存在医生短缺和分布不均的问题。本研究旨在以时间顺序记录省政府在 35 年期间推出的旨在帮助解决该问题的计划，并通过这些计划作为案例研究来检查政策实施的几个方面。
采用计划分析方法来审查广泛计划中的每一个，以确定其引入年份、战略类别、复杂性、时间框架和预期结果。根据计划启动的时间顺序构建了一个时间表，在此基础上分析了省政府从 1969 年到 2004 年使用的策略的变化。
在研究期间引入了许多计划，可以将其分为九个战略类别。政策工具的使用范围在后来的年份变得更加广泛。但明显缺乏指令性计划。近年来推出的计划往往更加复杂，更有可能具有更长的时间视角并更加注重医生的保留。该研究还讨论了政策工具的选择和多种策略的使用。
如果没有考虑实施情况，对政策的审查是不完整的。该研究揭示了一个反复试验的实验过程和过去经验的积累。该研究阐明了政策、政策实施以及政策工具和计划的使用之间错综复杂的关系。
