Federalism and Health Policy: The Development of Health Systems in Canada and Australia

Abstract

In past 15 years, a host of cross-national studies has examined diverse approaches to economic development, social welfare, political economy, and policy making. They have typically taken economic development as their selection criterion, thus juxtaposing industrially sophisticated countries as unlike as France and Japan. The aims of these comparisons have ranged as widely as their methodologies; sometimes neither has been overly explicit. Several works, however, have gained focus by controlling for such variables as geographic size, population, or cultural similarities. By favoring depth over breadth, some have been able to justify limiting their scope to a few smaller countries like Canada, Australia, Sweden, and Argentina. Gwendolyn Gray's Federalism and Health Policy: The Development of Health Systems in Canada and is thus hardly first work to recognize multitude of parallels in scale, standard of living, political tradition, and history between Canada and Australia, but hers is among first to compare development of health policy in two Commonwealth countries. Gray, a political scientist at Australian National University, originally had intended her study as an exploration of the relationships between federalism, ideology, and social-policy development in Australia (xiv). She later incorporated Canada into her analysis in hopes of challenging assumptions about federalism, centralization, and government power that prevail among Australian political scientists, Her thesis is that development of Canadian and Australian health policy offers a singular opportunity to test orthodox and revisionist theories in federalism literature. The former, first espoused by James Madison, holds that division of power among constituent political units is a safeguard that constrains exercise of that power, at least at federal level. Canada, where decentralized federalism supposedly both retarded adoption of welfare policies and impeded dismantlement once they were in place, is a case ir point. Revisionists, by contrast, see federalism as actually facilitating growth of government by very proliferation of gov-