1 Geography Program, University of Northern British Columbia, Prince George, British Columbia, Canada.
2 School of Business, University of Alberta, Edmonton, Alberta, Canada.
Int J Health Serv. 2019 Jan;49(1):51-67. doi: 10.1177/0020731418807094. Epub 2018 Oct 18.
This article critically exams efforts to achieve primary health care reform using a consultative and relationship-building approach. The study is set in a predominantly rural region of British Columbia, Canada, and concerns the efforts of a regional health authority to engage actively with community members to develop more integrated and patient-centered primary health care delivery. We examine points of tension between providers and administrators engaged in the reform process and show how these are often expressed discursively as a binary opposition involving central and local interests. We offer a critical examination of this politics of scale and seek to unpack claims of hierarchy and power as a means to offer insight into health care reform processes more generally.
本文批判性地考察了使用协商和建立关系的方法来实现初级卫生保健改革的努力。该研究位于加拿大不列颠哥伦比亚省的一个以农村为主的地区，涉及区域卫生当局积极与社区成员合作，以发展更具整合性和以患者为中心的初级卫生保健服务的努力。我们考察了参与改革进程的提供者和行政人员之间的紧张点，并展示了这些紧张点如何经常以涉及中央和地方利益的二元对立的形式在话语中表达出来。我们对这种规模政治进行了批判性的考察，并试图剖析等级和权力的主张，以此来更深入地了解更广泛的卫生保健改革进程。
