Health Profession Organizations in the Health Policy Process: A Comparative Case Study of Ontario and Saskatchewan

Abstract

This dissertation examined the factors that contributed to the increase of the professional autonomy for the nursing, pharmacy, and dietetics in Ontario and Saskatchewan. Using concepts drawn from the literatures of medical dominance and professional autonomy, this study applied and modified the advocacy coalition framework to examine the complex network of medical knowledge and health stakeholders involved in this health policy subsystem. A comparative case study explored the institutions that shape PHC services within their provincial health care systems, as well as the political and social contexts that propelled the idea of expanding scopes of practice within PHC reform efforts. This case study demonstrated that despite the increased recognition of the expertise of health professions to apply medical knowledge in a broader manner for PHC, the structural embeddedness of medical dominance within health care systems continues to reinforce the central role of the medical profession in health care. In Ontario, policymakers have taken a heavy-handed approach to implementing policy decisions that affect the division of health labour, while health professions continue to maintain control over these decisions in Saskatchewan. In both provinces, health professional organizations have greater influence over policy decisions that affect the regulation and scopes of practice of their members, but little influence of funding decisions and governance structures of PHC models. In addition, PHC funding are still largely dependent on the outcomes of the physician services negotiations. This dissertation demonstrated that while health professions have increased their clinical and political autonomies to some extent, medical dominance continues to affect the division of health labour. These results highlight the futility of provinces to achieve PHC reform efforts when policy decisions continue to reinforce the central role of the medical profession in the delivery of health care.