A critical analysis of recent Canadian health policy: models for community-based services

As part of the thrust by Health and Welfare, Canada, to strengthen community health services, the National Health Research and Development Program commissioned a series of literature reviews. I undertook to review organizational models for community-based services, but said that this would be done in the context of the developing organization of the national health insurance program. With the help of colleagues I examined the literature from a number of different viewpoints. This article will present our findings on the development of policy and will trace the difficulties in making a shift towards providing more care in the community. We found that organization theories were helpful for explaining developments in the health service as a whole and the place of community-based services within it. We were able to use these theories to analyse efforts at restructuring. They provide explanations for the concurrent existence of policies of rationalization and cutbacks with policies of expansion in the area of health promotion.