title: Managing under managed community care: the experiences of clients, providers and managers in Ontario's competitive home care sector.
abstract: In 1996, a newly elected government in the Province of Ontario, Canada, introduced a managed competition environment into the home care sector through the establishment of a competitive contracting process for home care services. Through 65 in-depth, semi-structured interviews conducted between November 1999 and January 2001, we trace the implementation of this competitive contracting policy within Ontario's newly established managed community care environment and assess the effects of competitive contracting against two sets of goals: (1). quality of care goals that consider continuity of care of paramount importance in the provision of home care; and (2). the managed competition goal of increased efficiency. In assessing the implementation of this policy against these goals, we highlight the conflicts that can arise in pursuing different policy goals in response to different formulations of the policy problem that underpin them. We map stakeholder experiences with the competitive contracting policy onto relevant contracting and managed competition literatures. When measured against the goals of quality of care and efficiency, the findings presented here offer a mixed review of the experiences to date with the competitive contracting process introduced in Ontario's home care sector and suggest improvements for managing future competitive contracting processes.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, Health Sciences Centre, McMaster University, Rm 3H28, 1200 Main Street West, Hamilton, Ont, Canada L8N 3Z5. abelsonj@mcmaster.ca
authors.forename: Julia
authors.initials: J
authors.lastname: Abelson
authors.forename: Sara Tedford
authors.initials: ST
authors.lastname: Gold
authors.forename: Christel
authors.initials: C
authors.lastname: Woodward
authors.forename: Denise
authors.initials: D
authors.lastname: O'Connor
authors.forename: Brian
authors.initials: B
authors.lastname: Hutchison
mesh_terms: D001291:Attitude of Health Personnel; D019090:Case Management; D003164:Competitive Bidding / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D003266:Continuity of Patient Care; D017598:Efficiency, Organizational; D006284:Health Plan Implementation; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006699:Home Care Services / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D006801:Humans; D007373:Interinstitutional Relations; D007400:Interprofessional Relations; D007407:Interviews as Topic; D018854:Managed Competition / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D017146:Models, Organizational; D009864:Ontario; D019982:Organizational Case Studies; D011369:Professional-Patient Relations