Healthcare

Abstract

The differences and similarities in health policy between the United States (U.S.) and Canada provide useful examples of how political institutions can shape democratic governance. These institutions have shaped both the obstacles to rapid welfare state expansion and the nature of the political reform coalitions that have been able to break through those obstacles. This chapter explores contending explanations of welfare state development, and then develops an institutional approach with which to parse though crucial differences between the U.S. and Canadian welfare states, and policy evolution in their healthcare systems. The chapter focuses on the role that political institutions have played in influencing national policy choices and in explaining policy differences between the U.S. and Canada. This comparison also bridges institutionalist theories with a more nuanced understanding of the way in which institutional arrangements interact with parties, policies, and welfare state outcomes.