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Ideas and the Pace of Change

Ideas and the Pace of Change: National Pharmaceutical Insurance in Canada, Australia, and the United Kingdom

Copyright Date: 2015
Pages: 232
  • Book Info
    Ideas and the Pace of Change
    Book Description:

    Canada is the only OECD country that has universal, comprehensive public hospital and medical insurance but lacks equivalent pharmaceutical coverage. InIdeas and the Pace of Change, Katherine Boothe explains the reasons for this unique situation. Using archival, interview, and polling data, Boothe compares the policy histories of Canada, the United Kingdom, and Australia in order to understand why Canada followed a different path on pharmaceutical insurance.

    Boothe argues thatpacematters in policy change. Quick, radical change requires centralized political institutions, an elite consensus, and an engaged, attentive electorate. Without these prerequisites, states are far more likely to take a slower, incremental approach. But while rapid policy change reinforces the new consensus, incremental progress strengthens the status quo, letting development stall and raising the bar for achieving change.

    An important contribution to the study of comparative political economy,Ideas and the Pace of Changeshould be required reading for anyone seeking to understand why health care reforms succeed or fail.

    eISBN: 978-1-4426-1737-7
    Subjects: Public Health, Health Sciences, Political Science

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface and Acknowledgments
    (pp. vii-2)
  4. Chapter 1 Re-examining Health System Variation
    (pp. 3-18)

    Canada prides itself on its universal, comprehensive, public health care system, which guarantees all citizens access to hospital and medical care, regardless of ability to pay. The fact that Canada has no similar nationwide program for pharmaceuticals might come as a surprise to Canadians who have adequate private, employer-sponsored drug insurance. However, it is a problematic and at times catastrophic reality for many other Canadians who do not have private insurance, do not have sufficient insurance, or are ineligible for the patchwork of provincial drug programs that are generally targeted by age or income or both.

    The lack of universal...

  5. Chapter 2 Explaining Stability and Change
    (pp. 19-46)

    The pace of policy change matters because it has long-term implications for the scope of policy development. A country’s pace of change in a given policy area is predictable on the basis of a combination of institutional, ideational, and electoral factors present at an early critical moment – in this case, the post–Second World War “welfare moment” experienced in many Western countries. Radical policy development requires centralized political institutions, elite consensus on an idea that links ideology and policy action, and a public that is both attentive to the policy domain and supportive of program adoption. In the absence...

  6. Chapter 3 Radical Reform or Incrementalism
    (pp. 47-82)

    As the Second World War was ending, many of the mature democracies we now call liberal welfare states were debating health policies. The idea of broader government involvement in the provision of health services or insurance was not new: each study country was involved in some level of organizing, regulating, or funding health programs in the first half of the twentieth century. In the United Kingdom, Liberal chancellor of the exchequer Lloyd George introduced a National Health Insurance program in 1911 that covered a limited range of services for workers (Klein 2010; Hacker 1998). In Canada in the 1920s and...

  7. Chapter 4 Entrenched Ideas and Barriers to Major Change
    (pp. 83-119)

    The previous chapter sought to explain why countries adopted either a radical or an incremental pace of health policy development. This chapter turns to the next element of the theoretical story. Why and how does the pace of change matter for policy outcomes? This chapter argues that the limited ideas and public expectations that help initiate an incremental pace of change also have a long-term effect on policy outcomes because they increase the barriers to major change, such as the adoption of additional public health services. Actors adapt their expectations for policy on the basis of what has happened in...

  8. Chapter 5 Opportunities for Minor Change
    (pp. 120-139)

    Studying the role of entrenched ideas in blocking major policy change also provides an opportunity to investigate the role of ideas in minor policy change – adjustments to policies that do not significantly and immediately change the range of services covered or the portion of the population receiving benefits. This chapter investigates the role of ideas in minor changes to services in Australia and the United Kingdom. It will not provide an exhaustive review of policy reforms but will instead focus on the first changes to pharmaceutical services in both countries, as they adopted very similar reforms in response to...

  9. Chapter 6 Explaining Major Change: Rare Conditions for Program Expansion
    (pp. 140-162)

    Thus far, this book has argued that certain conditions make a country more likely to take a slow, incremental approach to health policy development versus a radical approach, and that the pace of policy development matters because incremental processes tend to create significant barriers to the later expansion of public health services. This chapter sets out the rare conditions when these barriers can be overcome, asking when and how countries that adopt an incremental pace of health policy development can accomplish major change later in the process.

    One barrier to change occurs because, in the absence of public policy development,...

  10. Chapter 7 Conclusion
    (pp. 163-176)

    This book has sought to provide a new answer to an understudied empirical puzzle: why Canada lacks a nationwide, public, and universal pharmaceutical insurance program. In doing so, it has made a number of theoretical claims. First, that the pace of policy development and change is predictable, based on the institutional, ideational, and electoral conditions present at an initial critical moment. Of course there are still elements of contingency here, as in almost any social process, but the pace of policy development is neither random nor atheoretical. If we observe certain institutional, ideational, and electoral conditions, we should expect to...

  11. Notes
    (pp. 177-182)
  12. Works Cited
    (pp. 183-204)
  13. Index
    (pp. 205-218)
  14. Back Matter
    (pp. 219-221)