Purchase for Profit: Public-Private Partnerships and Canada's Public Health Care System

By Leach, Nicole | Canadian Review of Social Policy, Fall 2016 | Go to article overview

Purchase for Profit: Public-Private Partnerships and Canada's Public Health Care System


Leach, Nicole, Canadian Review of Social Policy


Purchase for Profit: Public-Private Partnerships and Canada's Public Health Care System by Heather Whiteside. University of Toronto Press, 2015. ISBN: 9781442651203

Standing in at 203 pages, Heather Whiteside's Purchase for Profit: Public-Private Partnerships and Canada's Public Health Care System punches high above its weight. Whiteside provides both a robust critical political economy framework for deciphering the initiation and ongoing development of public-private partnerships (P3) in the Canadian health care system, as well as showcasing the strength of her framework through two thorough case studies of Ontario and British Columbia's public-private partnership hospital developments.

Various studies, authors, and critics have explored the ideological nature of P3s, their failure to live up to cost efficiency claims, and their poor performance track histories. The power of Whiteside's study lies in its comprehensive tackling of all of these factors as well as outlining both the historical and institutional context in which P3s reside. This comprehensive tackling is made possible through Whiteside's utilization of a critically developed political economy framework.

Whiteside initiates her study by outlining her robustly developed critical political economy perspective, influenced by David Harvey's theorisation of temporal-spatial fixes to capitalisms tendency toward over-accumulation crisis (chapter 1). Whiteside provides a concise introduction to recognising capitalism as a crisis prone mode of production that constantly needs to shift and adjust to look for opportunities for market expansion in these moments of crisis to find new avenues of profitability. Whiteside (2015) explains that "this new plane will typically involve three elements: the penetration of capital into new spheres of activity (by reorganising pre-existing forms of activity along capitalist lines), the creation of new social wants and needs, and geographic expansion into new regions" (p.18). Utilizing Harvey's scholarship adds to this analysis the idea of "temporal displacement to account for long-term investments in physical and social infrastructure" (Whiteside, 2015, p. 18). Whiteside is able to privilege a nuanced deciphering of the neoliberal restructuring of Canadian health care policy and capital procurement policies through the 1980s, and P3 hospital project implementation starting principally the 1990s, along the motivation of displacing crisis tendencies (2015, p. 21). Rather than being presented as a purely ideological project, Whiteside's framework is able to provide a material and economic explanation of specific policy development trends (this history is richly developed across chapters 2 and 3).

The development and expansion of P3 development in Canada is a complex and nuanced history. P3 development does not take place uniformly, nor does it take place in a bubble. Whiteside cogently tracks not just the uptake in P3 projects, but the full development of P3 policy and institutional support, what Whiteside names P3-enablign fields. P3 enabling fields are, "the constellation of legal and institutional arrangements that facilitate, encourage, and allow for P3 projects and programs; inherently transformative influencing pre-existing structures and relationships and continually adapting to new circumstances and challenges; largely responsible for ridding jurisdictions of the pre-existing bias towards traditional project procurement through routinizing, institutionalizing, and depoliticizing dispossession" (2015, p. …

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