Beyond the art of governmentality: unmasking the distributional consequences of health policies.
The aim of this article is to critique health policy discourses that are taken for granted. This perspective will allow for the identification of 'exclusionary' health policies, which we define as policies that are thought to offer universal benefit, despite yielding adverse effects for significant groups of people in society. As such, policies that are said to be designed 'for all' frequently benefit only a subset of the population. Our intent is to highlight the distributional consequences of certain health policies that are largely institutionalized in contemporary society. We believe that these distributional effects are explicit representations of power in society and that institutions may provide individual 'choice' and 'freedom' that, in turn, yields separation as an outcome, a separating equilibrium. Specifically, if those who benefit from policies of partition are numerous and are to obtain significant advantage or incur limited costs, or if those who are adversely affected are scarce (or hidden), or the size of these adverse effects are small (or perceived to be minor), then partition becomes more likely as a 'legitimate', but exclusionary, instrument of public policy.
Coyte
Peter C
PC
Department of Health Policy, Management, and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. peter.coyte@utoronto.ca
Holmes
Dave
D
D001294:Attitude to Health; D002755:Choice Behavior; D003695:Delivery of Health Care; D005610:Freedom; D006076:Government; D015276:Health Care Rationing; D006291:Health Policy; D006801:Humans; D018802:Patient-Centered Care / Q000458:organization & administration; D011050:Policy Making; D011209:Power, Psychological; D011287:Prejudice; D011049:Social Control Policies; D012930:Social Dominance; D012935:Social Justice; D012945:Social Values; D012946:Social Welfare