How do Governments Steer Health Policy? A Comparison of Canadian and New Zealand Approaches to Cost Control and Primary Health Care Reform

Abstract

This paper compares the ways in which governments in Canada and New Zealand have attempted to pursue reforms in two major health policy arenas – cost control and primary health care – in the period 1992–2005. The framework for comparison is drawn from the “modes of governance” literature that deals with hierarchies, markets, provider-based networks and communities as means of steering policy. Recent literature has argued that governments are increasingly mixing and matching different modes of governance. This comparison shows that governance versatility applies in New Zealand, but not Canada, and this is primarily attributable to the differences in health policy institutions.