Almost Home is a rich and comprehensive study of the policy questions underlying the shift in medical care from hospitals to homes and communities, a change that is reshaping Canadian health care policy and politics. Using document analysis, and interviews with government officials and other key stakeholders in the policy community, the authors analyze the policy content and process of five different attempts to reform home and community care in Ontario between 1985 and 1996, as introduced by governments from three different political parties.

As this study demonstrates, the ongoing shift from the Medicare 'mainstream' of physician and hospital care to the Medicare 'margins,' entails not only a shift in the site of care but an erosion of the post-war state's role in health care. While Medicare continues to resist political and ideological forces aimed at shrinking the state's role, cost constraints, demographic pressures and technological advancements are increasing pressure on home and community care.

The authors have made a significant contribution to research on policy development and change. Their rigorously analytical approach fills a major gap in book-length literature on long-term health care in Canada.

Patricia Baranek has an adjunct position in the Department of Health Policy, Management, and Evaluation at the University of Toronto.

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Raisa B. Deber is a professor at the Institute of Health Policy, Management and Evaluation in the Faculty of Medicine at the University of Toronto.

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A. Paul Williams is an associate professor in the Department of Health Policy, Management, and Evaluation at the University of Toronto.

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