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Ideas and the Limits on Program Expansion: The Failure of Nationwide Pharmacare in Canada Since 1944

  • Katherine Boothe (a1)

Abstract. This article investigates the limits that ideas place on the scope of policy expansion though an empirical puzzle. Canada lacks a nationwide, universal pharmaceutical insurance program, which contrasts with the experience of most mature welfare states and Canada's own broad public hospital and medical insurance. The article find that ideas matter in policy development because of the mechanisms put in place by the pace of change. A slower, incremental process of policy development leads to restricted policy ideas that limit opportunities for program expansion. The article finds evidence of a reciprocal relationship between policy ideas and public expectations in four proposals for nationwide pharmaceutical insurance in Canada between 1944 and 2002.

Résumé. Cet article examine les limites qu'imposent les idées à la portée du déploiement des politiques publiques, et ce à partir d'un paradoxe empirique : le Canada n'a aucun programme national et universel d'assurance-médicaments, ce qui tranche avec la situation de la plupart des États-providence établis ainsi qu'avec son propre système public d'assurance maladie et hospitalisation. L'article montre que les idées influencent le développement des politiques publiques en raison des mécanismes qu'induit le rythme des réformes. Un processus de développement lent et graduel entraîne la formation d'idées restrictives, qui limitent les opportunités d'expansion des programmes. La constatation y est également faite d'une relation de réciprocité entre les idées et les attentes du public dans le cadre de quatre propositions d'établissement d'une assurance-médicaments nationale au Canada, entre 1944 et 2002.

Corresponding author
Katherine Boothe, Department of Political Science, McMaster University, 1280 Main Street West, Hamilton ON, CanadaL8S 4M4,
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