5. Roles and Responsibilities in Health Care Policy

Health System Organization and Governance in Canada and Australia: A Comparison of Historical Developments, Recent Policy Changes and Future Implications

“…These initiatives were intended to devolve authority from provincial health ministries to regional bodies that would have some measure of discretion in the allocation of health resources. In fact, these boards became operative when provincial governments were implementing tough cost-cutting measures (Maioni 2004).…”

The Organization of Decision‐making and the Dynamics of Policy Drift: A Canadian Health Sector Example

“…Using a historical‐institutionalist conceptual framework, it traces change (the dependent variable) over time and within the context of institutional variables, in an effort to understand their relationship to each other 7 . The relatively small portion of the historical‐institutionalist literature about the welfare state that has focused on health policy has mostly dealt with fairly macro‐institutional variables, such as federalism (Pierson 1995; Hacker 1998; Maioni 2002) and governance structures (Immergut 1998; Maioni 2002), or the overarching relationship of state to society in health policy. This study focuses instead on the organization of government ministries and agencies, arguing that the particularities of how welfare‐policy sectors are organized at this level can contribute to drift.…”

“…It is indisputable that federalism has been a highly salient factor in both the development and the resilience of core Canadian health care (Pierson 1995; Hacker 1998; Maioni 2002). But federal–provincial politics have relatively little effect on those aspects of the Canadian health care system where the majority of public–private change has been occurring.…”

“…In Canada, the public–private boundary is drawn by the Canada Health Act 1984 on the basis of types of services. Hospital and physician services are publicly insured under the Act, forming a highly resilient 9 core that is also the incessant focus of sometimes bitter, and all too often obfuscatory, federal–provincial wrangling (Boychuk 2002; Maioni 2002; Fierlbeck 2002; Lazar et al 2002). Threats to this core receive the greatest attention and pose the greatest potential political costs and most radical political‐economic transformations.…”

“…It is up to individual provinces to establish legislation and regulations in compliance with these terms if they wish to receive the transfer payments (and up to the federal government to monitor compliance). Obviously, then, should federal transfers shrink substantially – as they did with funding formula changes first in 1977 and especially in 1995 (Maioni 2002; Lazar et al 2002) – fiscal incentives for the provinces will likewise shrink, although electoral incentives will remain powerful, given the great popularity of the public scheme. Indeed, even Canadian identity is said to be shaped by the extent to which the single‐payer, universalist health care system distinguishes Canadians from their US neighbours (Mendelsohn 2002).…”