Distributed Democracy: Health Care Governance in Ontario

By Carey Doberstein

© 2020

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.

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Product Details

  • Series: IPAC Series in Public Management and Governance
  • World Rights
  • Page Count: 234 pages
  • Dimensions: 6.0in x 0.0in x 9.0in
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SKU# SP006422

  • PUBLISHED MAR 2020

    From: $45.00

    Regular Price: $60.00

    ISBN 9781487507251
  • PUBLISHED APR 2020

    From: $45.00

    Regular Price: $60.00

Quick Overview

This is the first book-length work to analyse Ontario’s Local Health Integration Networks

Distributed Democracy: Health Care Governance in Ontario

By Carey Doberstein

© 2020

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.

Continue Reading Read Less

Product Details

  • Series: IPAC Series in Public Management and Governance
  • World Rights
  • Page Count: 234 pages
  • Dimensions: 6.0in x 0.0in x 9.0in
  • Reviews

    "In Distributed Democracy, Carey Doberstein analyzes 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 on Ontario LHINs make it valuable to scholars of health policy, public policy and governance, and democratic theory, and also to policy makers and reformers in a range of complex governance arenas. Doberstein argues that the appropriate response to a sometime "messy or fuzzy" process of policy making 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

    "Doberstein’s book will stand as the reigning analysis and critique of Ontario’s 15-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
  • Author Information

    Carey Doberstein is an assistant professor of political science at the University of British Columbia.
  • Table of contents

    Acknowledgments 
    List of Acronyms 

    1. Introduction 
    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 

    References 
    End Notes

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