Best-Laid Plans: Health Care's Problems and Prospects

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McGill-Queen's Press - MQUP, Mar 26, 2002 - Health & Fitness - 196 pages
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Is health care like the BC Ferry Service or Ontario Hydro? Lawrie McFarlane and Carlos Prado argue that health care is being treated as though it were just another public utility and that the present crisis in medicare has developed precisely because of this approach. In The Best-Laid Plans they contend that what health care needs is less centralized management and the restoration of empowerment to both patients and care-givers. Contrary to recent attempts to reform health care, which have been based on the assumption that all health care needs is better management, McFarlane and Prado contend that what separates health care from other public services is the complex relationships between the service providers (doctors, nurses, physiotherapists, etc.) and their clients (patients), and the tendency for these relationships to evolve in unpredictable ways. Using Michael Foucault's "genealogical" and "ethical" analyses to explain the unpredictable nature of interactions in a high stakes, emotionally loaded environment, the authors demonstrate how planning, administration, delivery, and reform of a basic public service have gone wrong.
 

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Contents

Introduction
3
Health Care and Our Theoretical Base
9
Health Care and Power
25
Chaos Power and Ethics
63
The Origins and Pathology of Crisis
73
The Denial of Crisis
83
The Orthodox Approach to Health Care Reform
94
How Medicare Works
120
The Legal Context
131
The Historical Context
141
The Privatization Alternative
148
A New Approach to Managing Health Services in Canada
162
Notes
181
Bibliography
187
Index
193
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About the author (2002)

former deputy minister of health for the province of British Columbia

Queen's University

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