• David Rudoler, Allie Peckham, Agnes Grudniewicz, and Greg Marchildon.
• Faculty of Health Sciences, University of Ontario Institute of Technology, Canada; Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. Electronic address: david.rudoler@uoit.ca.
• Health Policy. 2019 Feb 1; 123 (2): 215-221.

AbstractIn this paper, we discuss the processes of policy layering as they relate to health care reform. We focus on efforts to achieve systems of coordinated primary care, and demonstrate that material change can be achieved through processes of incremental policy layering. Such processes also have a high potential for unintended consequences. Thus, we propose new principles of 'smart' policy layering to guide decision-makers to do incrementalism better. We then apply these principles to recent primary care reforms in Ontario, Canada. This paper conceptualizes 'smart' policy layering as a mechanism to achieve productive policy change in contexts with strong institutional barriers to reform.Copyright © 2018 Elsevier B.V. All rights reserved.

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