Decentralization in Public Health Systems: Analyzing the Decision Space and Opioid-Related Response in Edmonton Zone and Ottawa Public Health
Notice bibliographique
Résumé
This thesis explores how decentralization shaped the organization and function of public health systems in Canada through the comparison of Alberta and Ontario. Decentralization has been widely promoted as a way to increase responsiveness and local engagement in health systems broadly, while centralization is often seen as a means to improve coordination and efficiency. Several Canadian provinces have been pursuing centralization reforms in their health systems and the variation in public health systems across the provinces provides an opportunity for comparative analysis and learning. A comparative case study design was employed, focusing on Edmonton Zone (Alberta Health Services) and Ottawa Public Health as representative local public health units functioning in one system characterized as centralized (Alberta) and one as decentralized (Ontario). The Decision Space Analysis was used as an analytical framework to assess decentralization in both cases across key health system functions from 2011 to 2023. The opioid-related crisis served as a tracer for this study, adding another layer of focus to the data collection and analysis to explore how decentralization as a structure is related to public health responses. Data collection involved 41 documents and 10 key informant interviews for the Alberta case, and 45 documents and 9 key informants for the Ontario case. Content and thematic analysis techniques were used to conduct the Decision Space Analysis across health system domains such as financing, service organization, human resources and governance, and inductive analysis techniques were used to better understand how decentralization was experienced in general and for the tracer. Ottawa Public Health generally exhibited wider decision space than Edmonton Zone and differences emerged in areas of human resources and governance. However, the two local public health units also demonstrated similarities and overlap in areas of finance and service organization. Despite structural differences, both jurisdictions saw the implementation of comparable responses to the opioid-related crisis with some differences in approaches to safer supply programs. The potential reasons for these similarities and differences are explored. This study contributes to public health systems and services research by advancing a more nuanced and function-specific understanding of the structural arrangements in Alberta and Ontario’s public health systems, moving beyond simplistic dichotomies of centralization and decentralization. The utility of the Decision Space Analysis, both as an analytical framework and a way to understand policy debates, is also discussed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,008 |
| Études des sciences et des technologies | 0,011 | 0,010 |
| Communication savante | 0,006 | 0,002 |
| Science ouverte | 0,002 | 0,006 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».