The relationship between Saskatchewan's co-operative community clinics and the government of Saskatchewan : toward a new understanding

Abstract

This dissertation is a study of the public policy-making process, the role of ideas and relationships in this process, and their effect on social economy enterprises, in particular co-operatives. It is concerned with a central problem in all social economy organizations today: understanding the impact of public policy on funding, decision-making and strategy. The relationship between Saskatchewan’s co-operative Community Clinics and the provincial government is of particular interest. In spite of a seeming congruence between the goals of the Community Clinics and the government, the Clinics have not been allowed to play a significant role in reforming the delivery of health care services in the province.

The dissertation draws on models and concepts from the literatures on business–government relations, public policy and the policy-making process, the role of ideas and ideology in public policy, the social economy and public policy, and government–co-operative relations. A case study of the Community Clinics is elaborated through key informant interviews and supported by examination of primary and secondary literature.

This research shows that the Community Clinics are unique organizations and that a new understanding can be developed if the Clinics are viewed as hybrids – some combination of co-operative, public, and perhaps even private organizations. The ambiguity in the relationship arises at least in part from the differing and conflicting ways that the Community Clinics have been conceptualized by the politicians, government officials, the health regions, and even the Clinics themselves. The research also shows that the dominant idea at play in the health care policy domain in Saskatchewan remains that of private medical practice, with fee-for-service remuneration, and that the conditions necessary for a major policy change with respect to the role of the Community Clinics do not exist.