The Games Behind the Structure

An Evaluation of the Budgetary Process in the Quebec Health Care System

Abstract

This paper analyses the budgetary process of the Quebec health and social services system from three different perspectives: chronological, i.e. a retrospective longitudinal analysis of its evolution over the last fifteen years; systemic, i.e. a logistical study of the budgetary process defined as an organizational decision-making system; and micro-political, i.e. a strategic analysis of the dynamic behavior of the actors involved in this process. The triangulation of these three approaches helped to evidence the nature and extent of the political gamesmanship taking place within this process and the limits of the budgetary process defined as a rational decision-making system. From a methodological point of view, this research is an illustration of the use of multiple perspectives in the evaluation of complex organizations. Finally, this case study research was used as a basis for assessing the dynamics of the Quebec health and social services system's functioning within the framework of its global evaluation by a commission of enquiry system.