Rebalancing health systems toward community-based care: The role of subsectoral politics

Allie Peckham, Frances Morton-Chang, A. Paul Williams, Fiona A. Miller

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


There has been increased policy discourse urging a “rebalancing” of health systems from institutionally-based to community-based approaches. This paper offers an analysis of the subsectoral dynamics that condition opportunities to strengthen community-based care relative to acute care. We report on the results of a policy study in Ontario, Canada that explored factors impacting on the capacity to expand community-based care. In so doing, we highlight the challenges associated with the community subsector's ability to develop ‘critical’ status and challenge the dominance of the acute subsector. We conclude that attempts to rebalance health systems toward community-based care should begin by understanding that health care is not a monolithic policy sector, but rather a collection of proximate policy sub-sectors, inclusive of community care, acute care, and institutional care, each with their own internal characteristics and dynamics that impact sectoral directions.

Original languageEnglish (US)
Pages (from-to)1260-1265
Number of pages6
JournalHealth Policy
Issue number11
StatePublished - Nov 2018
Externally publishedYes


  • Acute care
  • Community-based care
  • Health policy
  • Health systems
  • Policy analysis
  • Subsector

ASJC Scopus subject areas

  • Health Policy


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