Institute of Health Policy, Management and Evaluation, University of Toronto College St, Suite 425, Toronto, Ontario M5T 3M6, Canada; North American Observatory on Health Systems and Policies College St, Suite 425, Toronto, Ontario M5T 3M6, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto College St, Suite 425, Toronto, Ontario M5T 3M6, Canada.
Health Policy. 2018 Nov;122(11):1260-1265. doi: 10.1016/j.healthpol.2018.09.014. Epub 2018 Sep 28.
There has been increased policy discourse urging a "rebalancing" of health systems from institutionally-based to community-based approaches. This paper offers an analysis of the subsectoral dynamics that condition opportunities to strengthen community-based care relative to acute care. We report on the results of a policy study in Ontario, Canada that explored factors impacting on the capacity to expand community-based care. In so doing, we highlight the challenges associated with the community subsector's ability to develop 'critical' status and challenge the dominance of the acute subsector. We conclude that attempts to rebalance health systems toward community-based care should begin by understanding that health care is not a monolithic policy sector, but rather a collection of proximate policy sub-sectors, inclusive of community care, acute care, and institutional care, each with their own internal characteristics and dynamics that impact sectoral directions.
已经有越来越多的政策讨论敦促医疗体系“重新平衡”，从以机构为基础的方法转向以社区为基础的方法。本文分析了影响相对于急性护理加强社区护理机会的分部门动态。我们报告了加拿大安大略省的一项政策研究的结果，该研究探讨了影响扩大社区护理能力的因素。在这样做的过程中，我们强调了社区部门发展“关键”地位的能力所面临的挑战，并挑战了急性部门的主导地位。我们的结论是，试图将医疗体系重新平衡到以社区为基础的护理方向，应该首先理解到医疗保健不是一个单一的政策部门，而是一个由临近政策分部门组成的集合，包括社区护理、急性护理和机构护理，每个部门都有自己的内部特征和动态，影响部门的方向。
