First Nations gatekeepers as a common pool health care institution: Evidence from Canada

This study investigates the roles of informal gatekeepers in the context of First Nations health care in Canada. While existing literature focuses on gatekeeping by professionals, such as corporate board members, auditors, general practitioners, and specialists, we present empirical evidence on the role of informal First Nations' gatekeepers in a health care system. Gatekeepers engage with government and First Nations along a continuum of gatekeeping functions. Drawing on common pool theory, we use a case study to understand the gatekeepers' roles. We identify First Nations gatekeepers' roles to include health care program control, resource control, and ecosystem control. We also find that these gatekeepers constitute a viable long-enduring common pool resource institution that can be useful for the federal government's phased approach in transitioning health care governance to the First Nations.