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

Raymond B. Blake is a history professor at York University.

Gwendolyn Gray, a political scientist at the Australian National
University, has two objectives in this book: first, to explore the
factors that led to the development of health-care systems in Canada and
Australia; and second, to use the development of health-care systems to
examine the validity of competing theories of federalism. At the outset,
she divides the vast literature on federalism into “orthodox” and
“revisionist” theories. The former holds that a federal division of
power acts as a severe constraint on the government to intervene in the
social and economic life of the nation: it acts, in other words, as a
barrier to change. In the revisionist view, federalism facilitates the
growth of government, allowing it to play a greater role in public
policy formation. Gray believes that Canada and Australia make a good
case study because Canadian federalism is very decentralized while the
Australian system is quite centralized.

Gray argues that political parties, party competition, elections,
ideologies, interest groups, economics, and the mobilization of public
opinion have all been important determinants of Canadian and Australian
health policy. As for the two competing theories of federalism, she
concludes that neither has universal application, and that it is
practically impossible to separate the independent effects of the
institutions of federalism from other policy influences. While Canada
and Australia share many common features, each federal system operates
in its own social, political, economic, and cultural settings, and a
quite different theory would be needed for each. Gray thus concludes
that any attempt to develop “a general theory of the impact of
federalism on the scope of government activity [is] likely to be
frustrated by insurmountable problems.”

For those interested in Canadian or Australian health policy in
particular or the emergence of social policy in general, this useful
book offers a thorough treatment of those subjects.