title: Competition, Organizational change, and conflict: the changing role of case managers in Ontario's homecare system.
abstract: As health care costs climb, governments continue to seek ways of controlling expenditures and improving accountability. One approach recently used by the government of Ontario to reform the delivery of homecare services focused on the introduction of competitive market forces in conjunction with the establishment of greater managerial controls over the activities of frontline health professionals. The purpose of this article is to assess how this "managed competition" model impacted the role of homecare case managers and their relationships with frontline health professionals. Data for this case study were obtained primarily through 36 in-depth key informant interviews with representatives from homecare provider agencies and the community care access centers (CCACs), which contract with the provider agencies for client services. The managed competition reform dramatically altered the role of homecare case managers by requiring them to take on greater responsibility for monitoring budgets and rationing services. This shift from a collaborative to a competitive system promoted conflict between case managers and other health care professionals. In the presence of an increasingly bureaucratized case manager role, interprofessional conflict and a focus on cost containment seems to have left clients without any clear advocate of their interests.
authors.affiliation: DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada. randalg@mcmaster.ca
authors.forename: Glen E
authors.initials: GE
authors.lastname: Randall
mesh_terms: D019090:Case Management; D003220:Conflict, Psychological; D017598:Efficiency, Organizational; D018166:Health Care Reform; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D018854:Managed Competition; D009864:Ontario; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011787:Quality of Health Care; D012941:Social Responsibility