Posted by 摘要
本文批判性地檢驗了使用協商和建立關係的方法實現初級醫療保健改革的努力。 該研究以加拿大不列顛哥倫比亞省的一個主要農村地區為背景，關注地區衛生當局為積極與社區成員合作以發展更加綜合和以患者為中心的初級衛生保健服務所做的努力。 我們研究了參與改革過程的提供者和管理者之間的緊張點，並展示了這些點如何經常被散漫地表達為涉及中央和地方利益的二元對立。 我們對這種規模政治進行了批判性的考察，並試圖解開等級制度和權力的主張，以此作為更普遍地洞察醫療改革進程的一種手段。
關鍵字：醫療改革, 網絡, 夥伴關係, 權力, 加拿大,
原文
Creating Partnerships to Achieve Health Care Reform: Moving Beyond a Politics of Scale?
Abstract
This article critically exams efforts to achieve primary health care reform using a consultative and relationship-building approach. The study is set in a predominantly rural region of British Columbia, Canada, and concerns the efforts of a regional health authority to engage actively with community members to develop more integrated and patient-centered primary health care delivery. We examine points of tension between providers and administrators engaged in the reform process and show how these are often expressed discursively as a binary opposition involving central and local interests. We offer a critical examination of this politics of scale and seek to unpack claims of hierarchy and power as a means to offer insight into health care reform processes more generally.
Keywords
health care reform, networks, partnerships, power, Canada