Not-So-New Public Management and the Denial of Geography: Ontario Health-Care Reform in the 1990s

New public management (NPM) has become the mantra for public sector restructuring in OECD nations. We critically examine NPM in the context of recent public sector restructuring initiatives in the province of Ontario, Canada. Two NPM-inspired reform mechanisms employed by the Ontario government—the benchmarking of hospital-utilization indicators and the offloading of a greater share of patient-care responsibilities to the private sector—are examined as they impact on the economically disadvantaged city of Thunder Bay in the province's remote Northwestern region. We argue that the health reforms pursued by the Ontario government are focused on a one-dimensional notion of efficiency which denies important socioeconomic and health-service-environment dimensions that account for local differences in health-services utilization. Although this type of reform approach achieves short-term cost savings, we question whether the longer term effects on health and social services are efficient and equitable from a systemwide perspective. Ultimately, we question whether NPM will solve the problems inherent in publicly supported health and social services or will generate a new set of problems linked to the belief in the primacy of market mechanisms.