The governance of health care in Ontario has long provided opportunities for citizens and stakeholders to participate, deliberate, and influence health care policy and investment decisions. Yet, despite providing opportunities for deliberation and influence amongst citizens, we don't know how democratic the system actually is.

Distributed Democracy advances an original analytical framework to guide an investigation of democracy and accountability relationships in complex policy making environments. Applying the analytical framework in the context of health care governance in Ontario from 2004–2019, Carey Doberstein shows that the popular criticisms of health care governance in Ontario are misplaced. The democratic system of local health care governance is often plagued by severed connections among the various layers of deliberation and policy-making. An incisive analysis with considerable relevance for policy-makers and across academic disciplines, Distributed Democracy makes an important contribution to our understanding of policy development and decision-making as well as the limitations and potential of distributed democratic accountability.