Lecture 9.docx

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21 Apr 2012
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Lecture 9:
Health Policy in Perspective: Canadian Federalism
Federalism
- Formation of federation to unite diverse communities
- Bicameral legislature: two hours
- Unitary = central
- Canada, US, New Zealand and Australia have a federal state
BNA Act & Constitution Act
- BNA Act, 1867 and amendments (1871, 1886, 1907, 1915, …) = Constitutional 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
o Executive is the prime minister and the cabinet
Evolution of Canadian Federalism
- Three periods:
o 1950s to early 1960s Cooperative federalism
o Mid-1960s to 1990s Executive federalism
o Mid-1990s into 2000s Collaborative federalism
- There is still intense relationship between the federal and provincial government
- The federal government whether liberal or conservative try to dictate the provincial government
on how to carry out health care
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
- 1997-present: Reparation of Social Union
Impact of Federalism on Health Care
- Primary care innovation in Canada have been shaped and to some extent bound 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
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