Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T19:53:47.175Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  24 May 2013

Katherine Boothe
Katherine Boothe*
Affiliation:
McMaster University
*
Katherine Boothe, Department of Political Science, McMaster University, 1280 Main Street West, Hamilton ON, CanadaL8S 4M4, boothek@mcmaster.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Type
Research Article
Information
Canadian Journal of Political Science/Revue canadienne de science politique , Volume 46 , Issue 2 , June 2013 , pp. 419 - 453
Copyright
Copyright © Canadian Political Science Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Advisory Committee on Health Insurance, Canada. 1943. Health Insurance. Ottawa: King's Printer.Google Scholar
Bachrach, Peter and Baratz, Morton S.. 1962. “Two Faces of Power.” The American Political Science Review 56 (4): 947–52.Google Scholar
Béland, Daniel and Cox, Robert Henry, eds. 2011. Ideas and Politics in Social Science Research. Oxford University Press.Google Scholar
Berman, Sheri. 1998. The Social Democratic Moment. Cambridge MA.: Harvard University Press.Google Scholar
Bhatia, Vandna D. and Coleman, William D. 2003. “Ideas and Discourse: Reform and Resistance in the Canadian and German Health Systems.” Canadian Journal of Political Science 36 (4): 715–39Google Scholar
Blyth, Mark. 1997. “‘Any More Bright Ideas?’ The Ideational Turn of Comparative Political Economy.” Comparative Politics 29 (2): 229–50.Google Scholar
Blyth, Mark. 2002. Great Transformations: Economic Ideas and Institutional Change in the Twentieth Century. Cambridge: Cambridge University Press.Google Scholar
Boothe, Katherine. 2012. “How the Pace of Change Affects the Scope of Reform: Pharmaceutical Insurance in Canada, Australia and the United Kingdom.” Journal of Health Politics, Policy and Law 37 (5): 779–814.Google Scholar
Burstein, Paul. 2003. “The Impact of Public Opinion on Public Policy: A Review and an Agenda.” Political Research Quarterly 56 (1): 29–40.Google Scholar
Canada. 1945. Dominion-Provincial Conference on Reconstruction: Plenary Conference Discussions. Ottawa: King's Printer.Google Scholar
Canada. 1965. “Proceedings of Federal-Provincial Conference, Ottawa, July 19–22, 1965.” Ottawa.Google Scholar
Canada. 2000. “First Ministers' Meeting Communiqué on Health.” Scics.Gc.Ca. Ottawa: Canadian Intergoernmental Conference Secretariat.Google Scholar
Canada. 2001. “Health Ministers Move Forward on Improving Health Care in Canada.” Releases.Gov.Nl.Ca. St. John's: Health Canada.Google Scholar
Canada. 2003a. “Budget 2003 Supports Social and Economic Agenda While Maintaining Balanced Budgets.” Ottawa: Finance Canada.Google Scholar
Canada. 2003b. “2003 First Ministers' Accord on Health Care Renewal.” Ottawa: Health Canada.Google Scholar
Canada. 2004. “A 10-Year Plan to Strengthen Health Care.” Ottawa: Health Canada.Google Scholar
Canada, Director of Investigations and Research. 1961. Material collected for submission to the Restrictive Trade Practices Commission in the course of an inquiry under section 42 of the Combines Investigation Act, relating to the manufacture, distribution and sale of drugs. Ottawa: Department of Justice, Appendix Q to RTPC Report.Google Scholar
Canada, Governor General. 1997. “Speech from the Throne—36th Parliament,” July 12, Ottawa.Google Scholar
Canada. House of Commons. 1967. Special Committee on Drug Costs and Prices (Harley Committee). 1967. Final Report. Ottawa: Queen's Printer.Google Scholar
Canada. Restrictive Trade Practices Commission. 1963. Report Concerning the Manufacture, Distribution and Sale of Drugs. Department of Justice: Ottawa.Google Scholar
Canadian Institute for Health Information. 2011. Drug Expenditure in Canada, 1985–2005. Ottawa: Canadian Institute for Health Information.Google Scholar
Canadian Pharmacists Association. 2001a. Submission to the Standing Senate Committee on Social Affairs, Science and Technology. Ottawa: Canadian Pharmacists Association.Google Scholar
Canadian Pharmacists Association. 2001b. Submission to the Romanow Commission on the Future of Health Care in Canada. Ottawa: Canadian Pharmacists Association.Google Scholar
CIPO/Gallup Poll of Canada, Public Opinion News Service Release (on microfilm), 1941–1960. All “most important problem facing the country/nation” questions.Google Scholar
CIPO/Gallup Poll of Canada, Public Opinion News Service Release, 1942, April 8 and May 22, 1943, April 8, 1944, July 13, 1949.Google Scholar
CIPO/Gallup Poll of Canada, Public Opinion News Service Release, 1943, February 6.Google Scholar
CIPO/Gallup Poll of Canada, Public Opinion News Service Release, 1948, July 24.Google Scholar
Commission on Pharmaceutical Services. 1971. Pharmacy in a New Age. Toronto: Canadian Pharmaceutical Association.Google Scholar
Commission on the Future of Health Care in Canada. 2002. Building on Values. Ottawa: Commission on the Future of Health Care in Canada.Google Scholar
Cutler, Fred. 2010. “The Space between Worlds: Federalism, Public Issues and Election Issues.” Regional & Federal Studies 20 (4-5): 487–514.Google Scholar
Daw, Jamie R, Morgan, Steve, Thomson, Paige A. and Law, M R. 2013. “Here today, gone tomorrow: The issue attention cycle and national print media coverage of prescription drug financing in Canada Health Policy.” Health Policy 110(1): 67–75.Google Scholar
Denzau, Arthur T., North, Douglass C and Roy, Ravi K. 2007. “Shared Mental Models: A Footnote.” In Neoliberalism: National and Regional Experiments with Global Ideas, ed. Roy, Ravi K., Willett, Thomas D and Denzau, Arthur T.. New York: Routledge.Google Scholar
Department of National Health and Welfare (Research and Statistics Division). 1963. Provision, Distribution and Cost of Drugs in Canada. Ottawa: Queen's Printer.Google Scholar
Douglas, Kristen. 2008. Patent Protection for Pharmaceutical Products in Canada—Chronology of Significant Events. Ottawa: Parliamentary Research and Information Service. http://www.parl.gc.ca/content/LOP/ResearchPublications/prb9946-e.pdf (accessed July 10, 2012).Google Scholar
Eastman, Harry. 1985. Report of the Commission of Inquiry on the Pharmaceutical Industry. Ottawa: Supply and Services Canada.Google Scholar
Environics Focus Canada Polls 1997–1 and 1997–2, Canadian Opinion Research Archives (queensu.ca/cora).Google Scholar
Erk, J. 2006. “Does Federalism Really Matter?” Comparative Politics 39 (1): 103–20.Google Scholar
Forest, PG. 2004. “To Build a Wooden Horse … Integrating Drugs into the Public Health System.” HealthcarePapers 4(3): 22–26.Google Scholar
Gorecki, Paul K. 1981. Regulating the Price of Prescription Drugs in Canada. Ottawa: Economic Council of Canada.Google Scholar
Grootendorst, Paul. 2002. “Beneficiary Cost Sharing Under Canadian Provincial Prescription Drug Benefit Programs: History and Assessment.” The Canadian Journal of Clinical Pharmacology 9 (2): 79.Google Scholar
Hacker, Jacob S. 1998. “The Historical Logic of National Health Insurance.” Studies in American Political Development 12: 57–130.Google Scholar
Hacker, Jacob S. 2004. “Privatizing Risk without Privatizing the Welfare State: The Hidden Politics of Social Policy Retrenchment in the United States.” The American Political Science Review 98 (2): 243–60.Google Scholar
Hall, Peter A. 1993. “Policy Paradigms, Social Learning, and the State: The Case of Economic Policymaking in Britain.” Comparative Politics 25 (3): 275–96.Google Scholar
Hay, Colin. 2011. “Ideas and the Construction of Interests.” In Ideas and Politics in Social Science Research, ed. Béland, Daniel and Cox, Robert Henry. Oxford: Oxford University Press.Google Scholar
Health Canada, Strategic Policy Branch. 2006. National Pharmaceuticals Strategy: Progress Report. Ottawa: Health Canada.Google Scholar
Howlett, M. and Cashore, B.. 2009. “The Dependent Variable Problem in the Study of Policy Change: Understanding Policy Change as a Methodological Problem.” Journal of Comparative Policy Analysis 11 (1): 33–46.Google Scholar
Hunter, Thelma. 1965. “Pharmaceutical Benefits Legislation, 1944–1950.” Economic Record September: 412–25.Google Scholar
Jacobs, Alan M. 2009. “How Do Ideas Matter? Mental Models and Attention in German Pension Politics.” Comparative Political Studies 42 (2): 252–79.Google Scholar
Jacobs, Lawrence R. 1993. The Health of Nations. Ithaca NY and London: Cornell University Press.Google Scholar
Jacobzone, S. 2000. OECD Labour Market and Social Policy Occasional Papers, vol. 40. Paris: OECD Publishing.Google Scholar
Jordan, J. 2009. “Federalism and Health Care Cost Containment in Comparative Perspective.” Publius: The Journal of Federalism 39 (1): 164–86.Google Scholar
Kapur, Vishnu, and Basu, Kisalaya. 2005. “Drug Coverage in Canada: Who Is at Risk?” Health Policy 71: 181–93.Google Scholar
Kingdon, John W. 1995. Agendas, Alternatives and Public Policies. 3rd ed. New York: Longman.Google Scholar
LAC. 1944a. Canadian Medical Association “Revised Principles Relating to Health Insurance.” May. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1944b. Conference of Canadian Health Organizations, health insurance booklet. January 28–29. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1946. Cabinet Committee on Dominion-Provincial Relations: Report of Working Committee on Health Insurance. January 4. Brooke Claxton fonds.Google Scholar
LAC. 1949a. Health Insurance Brief, 7 December. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1949b. Department of National Health and Welfare Memo, 22 December. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1950a. Final memo for submission to the Interdepartmental Committee on Social Security. 3 February. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1950b. G.D.W. Cameron to Paul Martin, 27 November. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1955a. Draft Report to the Chairman of the Preparatory Committee for the Federal-Provincial Conference. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1955b. Memo to Minister of Health, 5 August. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1962. Canadian Pharmaceutical Association submission to the Royal Commission on Health Services. May. Royal Commission fonds.Google Scholar
LAC. 1963. Meeting of the Departmental Group to Study Health Insurance, March 27. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1964. Combines Office to Dr. K.C. Charron re: Interdepartmental Committee on Drugs. October 23. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1971. Memo: “The Drug Price Program,” September 23. Ottawa: Privy Council Office.Google Scholar
LAC. 1972a. Cabinet Memos. February 2 and 8. Ottawa: Department of National Health and Welfare.Google Scholar
LAC. 1972b. Memorandum to Cabinet: “Measures to lower the unit price of drugs including a drug benefit program,” March 23 and 30. Ottawa: Privy Council OfficeGoogle Scholar
LAC. 1972c. Memorandum to Cabinet. November 24. Ottawa: Office of the Deputy Minister of Health and Welfare.Google Scholar
Lang, Ronald W. 1974. The Politics of Drugs. Farnborough, Hants, Lexington MA: Saxon House-Lexington Books.Google Scholar
Lexchin, J. 1993. “Pharmaceuticals, Patents, and Politics: Canada and Bill C-22.” International Journal of Health Services 23 (1): 147–60.Google Scholar
Lexchin, J. 1997. “After Compulsory Licensing: Coming Issues in Canadian Pharmaceutical Policy and Politics.” Health Policy 40: 69–80.Google Scholar
Liberal Party of Canada. 1993. Creating Opportunity: The Liberal Plan for Canada (Red Book). Ottawa: Liberal Party of Canada.Google Scholar
Liberal Party of Canada. 1997. Securing Our Future Together: Preparing Canada for the 21st Century. Ottawa: Liberal Party of Canada.Google Scholar
Library and Archives Canada (LAC). nd. Draft: “Some Social Reasons for Pharmacare.” Ottawa: Department of National Health and Welfare.Google Scholar
Lindblom, Charles E. 1982. “The Market as Prison.” The Journal of Politics 44 (2): 323–36.Google Scholar
MacDougall, Heather. 2009. “Into Thin Air: Making National Health Policy, 1939–45.” Canadian Bulletin of Medical History 26 (2): 283–313.Google Scholar
Mahoney, James, and Thelen, Kathleen Ann. 2010. Explaining Institutional Change. New York: Cambridge University Press.Google Scholar
Maioni, Antonia. 1998. Parting at the Crossroads. Princeton NJ: Princeton University Press.Google Scholar
Marsh, Leonard C. 1943. Report on Social Security for Canada Prepared for the Advisory Committee on Reconstruction. Ottawa: King's Printer.Google Scholar
Martin, Paul. 1985. A Very Public Life. Vol. II. Toronto: Deneau.Google Scholar
Mehta, Jal. 2011. “The Varied Role of Ideas in Politics: From ‘Whether’ to ‘How’.” In Ideas and Politics in Social Science Research, ed. Béland, Daniel and Cox, Robert Henry. Oxford: Oxford University Press.Google Scholar
Mendelsohn, Matthew. 2002. Canadians' Thoughts on Their Health Care System. Commission on the Future of Health Care in Canada. Kingston: Queen's University.Google Scholar
Mintzes, Barbara. 2007. “Should Patient Groups Accept Money From Drug Companies? No.” British Medical Journal 334 (7600): 935–35.Google Scholar
National Forum on Health (Canada). 1997. Canada Health Action: The Final Report of the National Forum on Health, vol. 1. Ottawa: National Forum on Health.Google Scholar
Noelle-Neumann, Elisabeth. 1999. “The Effect of the Mass Media on Opinion Formation.” In Mass Media, Social Control, and Social Change: A Macrosocial Perspective, ed. Demers, David and Viswanath, K.. Ames IA: Iowa State University Press.Google Scholar
North, Douglass C. 1990. Institutions, Institutional Change, and Economic Performance. Cambridge: Cambridge University Press.Google Scholar
Olson, Mancur C. 1971. The Logic of Collective Action. Cambridge MA: Harvard University Press.Google Scholar
Perry, John Harvey. 1989. A Fiscal History of Canada. Toronto: Canadian Tax Foundation.Google Scholar
Pierson, Paul. 1995. “Fragmented Welfare States: Federal Institutions and the Development of Social Policy.” Governance 8 (4): 449–78.Google Scholar
Pierson, Paul. 2000. “Increasing Returns, Path Dependence, and the Study of Politics.” American Political Science Review 94 (2): 251–67.Google Scholar
Pierson, Paul. 2001. “Coping with Permanent Austerity: Welfare State Restructuring in Affluent Democracies.” In The New Politics of the Welfare State, ed. Pierson, Paul. Oxford: Oxford University Press.Google Scholar
Royal Commission on Health Services. 1964. Report of the Royal Commission on Health Services. Ottawa: Queen's Printer.Google Scholar
Rx&D. 2010. “Where We Stand: Catastrophic Drug Coverage.” Policy, Research and Analysis Department. http://www.canadapharma.org/CMFiles/Our%20Industry/Where%20We%20Stand/WhereWeStand_DRAFT_CatastrophicDrugCoverage2.pdf.Google Scholar
Senate Standing Committee on Social Affairs, Science and Technology. 2002. The Health of Canadians: The Federal Role. Ottawa: Parliament of Canada.Google Scholar
Shillington, Clarence Howard. 1972. The Road to Medicare in Canada. Toronto: DEL Graphics.Google Scholar
Standing Committee on Industry. 1997a. 5th Report of the Standing Committee on Industry. Parl.Gc.Ca. Ottawa: Parliament of Canada.Google Scholar
Standing Committee on Industry, ed. 1997b. Evidence of the Committee. Parl.Gc.Ca. vol. 35. Ottawa: Parliament of Canada.Google Scholar
Taylor, Malcolm G. 1987. Health Insurance and Canadian Public Policy. Kingston and Montreal: McGill-Queens University Press.Google Scholar
Treff, Karin and Perry, David B.. 1997. Finances of the Nation 1996. Toronto: Canadian Tax Foundation.Google Scholar
Treff, Karin and Perry, David B.. 1998. Finances of the Nation 1997. Toronto: Canadian Tax Foundation.Google Scholar
Treff, Karin and Perry, David B.. 2002. Finances of the Nation 2001. Toronto: Canadian Tax Foundation.Google Scholar
Treff, Karin and Perry, David B.. 2003. Finances of the Nation 2002. Toronto: Canadian Tax Foundation.Google Scholar
Tuohy, Carolyn Hughes. 1999. Accidental Logics. New York: Oxford University Press.Google Scholar
Tuohy, Carolyn Hughes. 2011. “American Health Reform in Comparative Perspective: Big Bang, Blueprint, or Mosaic?” Journal of Health Politics, Policy and Law 36 (3): 571–76.Google Scholar