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Health Policy in Perspective: Canadian Federalism 3/22/2012 7:03:00 AM
Formation of federation to unite diverse communities
Bicameral legislature: two houses
Unitary (example: UK-national government)central.
Examples of federal states: Canada, USA, Australia, New Zealand. Prime minister
and house of cabinet.
BNA Act & Constitution Act
BNA Act, 1867 and amendments (1871, 1886, 1907, 1915, …) Constitution Act, 1982.
Create federation: provinces, territories, Parliament, provincial legislatures.
Prominent Trends in Public Policy Making
Shared vision and policy framework.
Governments working together more than in the past and with other sectors.
Incremental increases in public spending.
Federal recognition of authority and responsibility for most social and health programs in
provincial and territorial governments.
Expansion of knowledge base of policy sectors.
Executive dominance over legislative role.
Federal government used spending power to fund programs.
Evolution of Canadian Federalism
1950s to early 1960s Cooperative federalism
Mid-1960s to 1990s Executive federalism.
Mid-1990s to 2000s Collaborative federalism.
4 Phases of Canadian National Policy Change
1980-1984: Maintain the social safety net.
1984-1988: Social program costs restraint.
1988-1997: Restructuring State social role.
1977-present: Reparation of Social Union. (claim to improve intergovernmental issues
but we hear about war between two governments)
Impact of Federalism on Health Care
Primary care innovations in Canada have been shaped – and to some extent bounded –
by three policy legacies: (1) Canadian federalism, in which jurisdiction over health care
is assigned primarily to provincial governments; (2) the principle of public payment for
private medical practice on which Canada’s universal, publicly financed health insurance
system is based, and (3) the limitation of compulsory coverage to hospital and physician
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