Policy trade-offs in "home care": the Ontario example

As Canada enters the twenty-first century, its highly prized program, medic are, is undergoing radical transformation. With technological change and th e restructuring of health systems, the locus of care is shifting from insti tutions to the home. As a result, care that was formerly publicly financed under the Canada Health Act is technically becoming de-insured. This paper analyses the reform of community-based long-term care services in Ontario f rom 1985 to the present. During this period, three different parties, the L iberals, the NDP and the Progressive Conservatives, in turn, formed the gov ernment. Four different models were put forward before the current model wa s adopted by the current pc government. Each of these models is analysed wi th respect to design decisions that must be made in the policy dimensions o f financing, delivery and allocation and evaluated in terms of equity, libe rty, security and efficiency. Underlying the debate in Ontario was a fundam ental disagreement about the role of government, reflected in views about t he responsibilities of individuals and their families, and the appropriate place of for-profit organizations within a publicly funded system. The refo rm of this sector has significance that goes beyond its boundaries, with wi der implications and warnings for health care in general.