Roles of Non-Traditional Gatekeepers in Healthcare Governance : Case Study of a Canadian First Nations

While prior studies of gatekeepers have examined the roles of traditional gatekeepers defined as professionals with normative isomorphic obligations, this study explores the roles of non-traditional gatekeepers in an alliance that is neither hierarchical nor market based. Drawing on new institutional theory, our study investigates the roles that non-traditional gatekeepers play in Aboriginal health care delivery and how accounting is implicated. Canada's Health Centre of the Paul Band is our site of investigation. We find that three themes bear on the roles of non-traditional gatekeepers on Aboriginal health care governance: 1) eco-system control, 2) resource control and, 3) program control. We also find that accounting helps to facilitate the execution of these governance roles through internal and cost control mechanisms. Accounting inculcates standardized practices that are useful in resolving tensions in the health care alliance, but accounting controls also create bureaucratic restraints that have the unintended consequences of limiting access to health care and causing tensions in the alliance