| Summary: | The case study examines impacts on the exercise of power and the allocation of resources
in health care delivery in British Columbia stemming from provincial policies of
regionalization and devolution. The study examines the policy implementation process
from 1993 to 1999, with the emphasis falling on the policy controversy provoked by the
New Directions reform (1993 to 1996). The study also contributes to theory development
regarding the policy implementation process by expounding and applying an approach to
policy-as-ideology. Another subsidiary purpose is to contribute to theory regarding the
power and accountability of health care providers and lay members of health services'
governance structures. The study demonstrates the persistence of structural power
relations within the health care sector. It concludes that the health reform initiative failed
to impose controls over health care professionals and providers, failed to improve
accountability of programmes to the public, failed to affect a reallocation of resources in
the health sector, and failed to shift the policy perspective from the delivery of health care
services to a community health perspective. The reorganization that was achieved
through the reform did, however, strengthen administrative arrangements and improve
technical efficiency.
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