Distributed Democracy: Health Care Governance in Ontario
Published: March 2020© 2020
234 Pages, 6.20 x 9.10 x 1.00 in, 8 figures
The governance of health care in Ontario has long provided opportunities for citizens and stakeholders to participate, deliberate, and influence health care policy and investment decisions. Yet, despite providing opportunities for deliberation and influence amongst citizens, we don’t know how democratic the system actually is.
Distributed Democracy advances an original analytical framework to guide an investigation of democracy and accountability relationships in complex policy making environments. Applying the analytical framework in the context of health care governance in Ontario from 2004–2019, Carey Doberstein shows that the popular criticisms of health care governance in Ontario are misplaced. The democratic system of local health care governance is often plagued by severed connections among the various layers of deliberation and policy-making. An incisive analysis with considerable relevance for policy-makers and across academic disciplines, Distributed Democracy makes an important contribution to our understanding of policy development and decision-making as well as the limitations and potential of distributed democratic accountability.
List of Acronyms
2. The Democratic Arenas Framework
3. The Evolution of Health Care Governance in Ontario
4. Procedural Decision-Making Bodies that Enable and Constrain LHINs
5. LHINs as Mandated Decision-Making Sites
6. LHIN Advisory Committees and Public Engagement
7. A Democratic Arenas Analysis of LHINs
"In Distributed Democracy, Carey Doberstein analyses the relationship between democracy and accountability by taking a holistic view of a complex ‘deliberative ecosystem’: health governance in Ontario. The book’s compelling analytical framework and extensive empirical research make it valuable to scholars of health policy, public policy and governance, and democratic theory, as well as to policymakers and reformers in a range of complex governance arenas. Doberstein argues that the appropriate response to a sometimes ‘messy or fuzzy’ process of policymaking is not to abandon attempts at deliberative governance but rather to carefully assign criticism and reform efforts where they are most needed. This book provides an invaluable basis for doing so."Katherine Boothe, Department of Political Science, McMaster University
"Carey Doberstein’s book will stand as the reigning analysis and critique of Ontario’s fifteen-year experiment with Local Health Integration Networks as mechanisms of health care governance, offering penetrating insights into the strengths and weaknesses of what he terms this ‘deeply controversial and often misunderstood model.’ Beyond that significant contribution, however, Doberstein’s treatment of the LHINs within an original ‘democratic arenas framework’ provides an illuminating approach to the study of experimentalist governance well beyond the case of the LHINs and indeed beyond the health care arena itself."
Carolyn Tuohy, Munk School of Global Affairs and Public Policy, University of Toronto