Shifting Sands: Government-Group Relationships in the Health Care Sector

Paul G. Thomas is a political science professor at the University of
Manitoba and the co-author of Canadian Public Administration:
Problematical Perspectives.

This book—one in a series of publications on public-policy and
public-administration topics—is an intelligent and detailed analysis
of how health-care interest groups in four provinces have interacted
with governments.

The author uses several theoretical frameworks and case studies to
explain the evolving patterns of interest-group behavior and to
illuminate the complexity of the relationship between governments and
health professionals. Although the four provinces have faced similar
problems requiring a restructuring of their health systems, they have
responded in different ways. These differences reflect both the
political cultures of the particular provinces and their institutional
arrangements for dealing with health issues. For example, Ontario’s
efforts during the 1980s to restructure its dealings with health
professionals represented an enormous political and bureaucratic
investment in an effort to direct and co-ordinate the health system. For
the future, Boase predicts a more proactive, interventionist role for
governments in resolving disputes among health professions and in
allocating scarce resources. This sounds like an accurate (albeit rather
safe) prediction, but one based on deep knowledge of how the health-care
system has been evolving recently. The scholarship that supports
Boase’s analysis is impressive in its scope and maturity; however, the
book would not be easy reading for people outside the field.