Measuring the decision-making impact of applied health research should constitute a core function for many research funders and research organizations. Different target audiences warrant different measures of impact. The target audiences for applied health research include the general public, patients (and their families), clinicians, managers (in hospitals, regional health authorities and health plans), research and development officers (in biotechnology firms) and public policy-makers (i.e. elected officials, political staff and civil servants). Making meaningful assessments within peer groups that fund or produce similar types of research knowledge for similar types of target audiences makes more sense than a one-size-fits-all approach to impact assessment. User-pull and interactive measures of impact (i.e. measures of cultural shifts that would facilitate the on-going use of research knowledge to inform decision-making) can supplement more traditional producer-push measures that assess researchers' active efforts to inform decision-making and the outcome of these efforts. Cultural shifts may include the creation of a research-attuned culture among decision-makers and a decision-relevant culture among researchers. Moving beyond whether research was used to examine how it was used is also important. Research knowledge may be used in instrumental, conceptual or symbolic ways. These actions, coupled with on-going refinements to the proposed assessment tool as research evidence evolves, would take us a long way towards assessment and accountability in the health sector.

This historical-institutionalist case study of public-private change in the rehabilitation health sector in Ontario, Canada, seeks to build on literature about the politics of policy drift, particularly with respect to health care systems. Rather than turning to higher-order institutional factors, such as federalism and overall financing agreements between states and the medical profession, or to economic indicators such as change in expenditures, however, it posits that the particularities of how welfare-policy sectors are organized with respect to their decision-making contribute to drift. Such organization is framed by two factors. The first is the set of rules by which the publicprivate boundary is drawn, and the second is the structuring of public institutions that set legislation and regulation, and organize the policy networks attendant on them, around these boundaries. The degree of coordination or fragmentation among these, this case suggests, is a factor in the politics and dynamics of drift.

Abstract. There is a discussion in the literature about whether, to what extent, and in what ways the welfare state is retrenching or otherwise changing. Both the health policy literature and the broader policy studies literature have tended to focus on economic measures of privatization. This study tests the adequacy of the measures of public-private change proposed by Stoddart and Labelle (1984) by using them to track and analyze the sequence of policy changes in automobile legislation, workers' compensation and health that transformed Ontario's rehabilitation health sector from being almost entirely public in 1990 to being almost entirely private a decade later. It suggests adding what is called “allocative decision-making power” to indicators used to assess public-private change in order to more adequately capture transformations.Résumé. Assiste-t-on au déclin de l'État-providence ou à sa transformation? Quelle est l'ampleur du phénomène? Ce sont des questions qui ont été maintes fois examinées. Or, les analyses des politiques de santé ainsi que les études plus générales des politiques publiques ont tendance à se concentrer sur les mesures économiques de privatisation. La présente étude vise à tester la pertinence des mesures du changement public-privé proposées par Stoddart et Labelle (1984) en les appliquant à la série des changements de politiques en matière de réglementation automobile, d'indemnisation des travailleurs et de santé qui ont fait passer le secteur de la réadaptation du système de santé ontarien d'un statut presque entièrement public en 1990 à un statut presque entièrement privé une décennie plus tard. Cette étude propose d'ajouter la mesure de ce qu'on appelle “ la capacité à prendre des décisions d'allocation ” aux indicateurs traditionnels d'évaluation de l'équilibre public-privé, afin de mieux décrire les processus de changement.

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