Antonia Maioni

This Handbook chapter aims to describe and explain the course of reform in North American healthcare from the Great Depression of the 1930s to the years 2013–2014. First, there is a brief discussion of the place of such a compari- son in the broader field of comparative policy studies. Our approach, which follows a ‘close comparison’ mode of analysis, takes up in turn the decades of dispute over the proper role of government in the financing of healthcare services to its citizens. That history constitutes the bulk of the comparative nar- rative, but is supplemented by two additional elements: a case study of the role of courts in North American healthcare reform, and an extended discussion of the role of political institutions in explaining policy change and continuity more generally.

... Canada and the Quest for Health in the United States ANTONIA MAIONI Glass: ... In “Medical Science and Social Criticism,” Colin Howell traces a narrative biography of Alexander Reid, a Canadian health reformer influenced by the Progressive movement in the United States. ...

The differences and similarities in health policy between the United States (U.S.) and Canada provide useful examples of how political institutions can shape democratic governance. These institutions have shaped both the obstacles to rapid welfare state expansion and the nature of the political reform coalitions that have been able to break through those obstacles. This chapter explores contending explanations of welfare state development, and then develops an institutional approach with which to parse though crucial differences between the U.S. and Canadian welfare states, and policy evolution in their healthcare systems. The chapter focuses on the role that political institutions have played in influencing national policy choices and in explaining policy differences between the U.S. and Canada. This comparison also bridges institutionalist theories with a more nuanced understanding of the way in which institutional arrangements interact with parties, policies, and welfare state ou...

IntroductionInterest in multisectoral policies has increased, particularly in the context of low-income and middle-income countries and efforts towards Sustainable Development Goals, with greater attention to understand effective strategies for implementation and governance. The study aimed to explore and map the composition and structure of a multisectoral initiative in tobacco control, identifying key factors engaged in policy implementation and their patterns of relationships in local-level networks in two districts in the state of Karnataka, India.MethodsSocial network analysis (SNA) was used to examine the structure of two district tobacco control networks with differences in compliance with the India’s national tobacco control law. The survey was administered to 108 respondents (n=51 and 57) in two districts, producing three distinct network maps about interaction, information-seeking and decision-making patterns within each district. The network measures of centrality, densit...

Résumé Le Canada et les États-Unis doivent faire face à d’importantes remises en question de l’orientation de leurs systèmes de santé. Les débats dans les deux pays sont marqués par les mêmes préoccupations, notamment l’augmentation rapide des coûts, l’écart croissant entre l’étendue des services assurés, leur accessibilité et l’efficacité de leur gestion. Cet article examine l’évolution des réformes de l’assurance santé au Canada et aux États-Unis et se penche sur deux questions. En quoi les réformes de l’assurance santé entreprises dans les deux pays divergent-elles ou convergent-elles? Comment l’institutionnalisation d’un certain type de système d’assurance santé conditionne-t-il les réformes subséquentes? Il semble improbable que les systèmes de santé du Canada et des États-Unis évoluent dans le sens de la convergence. L’obstacle principal à une telle évolution réside dans la nature de leurs institutions politiques, qui conditionnent le débat politique et l’orientation de leurs ...

Intersectoral action (ISA) is considered pivotal for achieving health and societal goals but remains difficult to achieve as it requires complex efforts, resources and coordinated responses from multiple sectors and organizations. While ISA in health is often desired, its potential can be better informed by the advanced theory-building and empirical application in real-world contexts from political science, public administration and environmental sciences. Considering the importance and the associated challenges in achieving ISA, we have conducted a meta-narrative review, in the research domains of political science, public administration, environmental and health. The review aims to identify theory, theoretical concepts and empirical applications of ISA in these identified research traditions and draw learning for health. Using the multidisciplinary database of SCOPUS from 1996 to 2017, 5535 records were identified, 155 full-text articles were reviewed and 57 papers met our final i...

This paper examines some of the recent changes in the Canadian health care system and describes some of the market incentives in the helath care sector. In contrast to European health care systems in transition, the extent and potential for market incentives is still very limited in the Canadian context.

Introduction: Why Health Care is so Important to Canadians 1. The History of Health Care in Canada 2. A Portrait of Health Care in Canada 3. The Facts about Health Care Spending 4. Why No National Insurance in the United States? 5. Comparing Canada and Europe 6. Provincial Snapshots 7. The Double-Edged Sword of Health Care

As in Canada, the challenges of health care reform are a constant political refrain in electoral battles in the United States. Since the 1940s, in fact, successive presidential elections have been marked by the issues of health care access, cost, and coverage. The failure of Harry Truman's fair deal proposals and the success of Lyndon Johnson's great society project both had core visions for health reform, while the more recent challenges faced during Bill Clinton's first term in office underscore the persistent problems in addressing health care issues in the US.1The 2008 election year lived up to its promise of political spectacle, with a showdown between Hillary Clinton and Barack Obama for the Democratic nomination, and the fresh image of Sarah Palin recasting the Republican ticket with John McCain. In the vortex of the personality politics that dominated the campaign, it remained important not to lose perspective on the real political issues of the contest. The policy stakes between the parties were real and salient for voters and candidates alike. And although the economic crises of the fall 2008 would dominate headlines, health care reform remained a main ballot box issue in the November election.HEALTH CARE IN THE 2008 CAMPAIGNIn most US political contests, "pocketbook" issues tend to dominate voter concerns, particularly in worsening economic times. Members of the babyboom generation have become increasingly insecure about their health-care future as costs soar and even middle-income Americans remain worried about being able to afford health care.The stakes also are high for businesses grappling with how to insure workers in an economic downturn and how to compete with firms in other countries - including Canada - that don't have to shoulder that burden directly. Yet even though a good number of business leaders recognize the need for health reform, the business community remains divided on the nature of needed change and has been unable to sustain or support concerted legislative efforts.2Moreover, the persistent problem of the uninsured - 47 million at last count - haunts every political candidate.3 Why the US can spend so much on health care and yet have so many residents uninsured has led to a lively scholarly debate, but the question of the uninsured is of key practical concern as well .4 This is because access to health care in the US depends on insurance coverage, not citizenship, as is the case in practically every other industrialized country.In fact, in the United States today, in sharp contrast to Canada, access to care is not guaranteed. Instead, access to care depends on one's insurance coverage, which varies widely between individuals and is determined by state of residence, employment status, financial capacity, age, and disability. Most Americans (and their dependents) are covered through voluntary employment-based health insurance, in which they share in paying the costs of premiums with their employer. A small minority carry individual private insurance.So, while Canadians bemoan rising taxes and politicians fret about increases in health care budgets, our concerns are largely about the collective impact of rising health care costs. In the US, meanwhile, those costs are felt directly in people's wallets. As the economy tightens and the potential for unemployment rises, so too does the possibility of losing coverage. But financial squeezes also come into play for the employed, since many low-wage workers cannot afford to pay health insurance premiums, while most part-time workers are not offered those benefits at all.As in Canada, health care reform in the US is also about government programs, public spending, and fiscal federalism. This is because government involvement in health care is substantial, through major federal legislation instated in the 1960s, through tax subsidies for health insurance for employees and the self-employed, and through extensive regulations of insurers and health maintenance organizations. …

Ce texte pose trois questions sur le rapport entre les valeurs et l’elaboration des politiques publiques : en quoi les valeurs sont-elles importantes pour comprendre le developpement des politiques publiques ? Quelle est la portee de cette importance et quels sont les problemes associes a l’interpretation des valeurs ? Quelle est la source de ces valeurs et la facon dont elles peuvent etre reconciliees, particulierement dans une situation de gouvernance distribuee ? Selon l’auteur, il y a des limites importantes a l’utilite des valeurs dans l’analyse du developpement des politiques publiques, de meme que des pieges dans le fait d’encadrer l’elaboration des politiques publiques dans un discours lie aux valeurs.