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Looks at the USA, Britain and Canada to offer an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. The book explores what drives change and why certain changes occur in some nations and not in others

AbstractThe apparent defeat of the medical profession on the issue of extra-billing presents an anomaly, in light of the historical and comparative literature on the political power of medicine and the more general interest group literature regarding the disproportionate political influence of concentrated interests. On closer examination, the extra-billing episode suggests some modifications to theories of the political advantage of concentrated interests, but does not present a deviant case. It rather provides an example of the political vulnerability of concentrated interests on issues of broad symbolic appeal; it illustrates the ability of a concentrated group to use its traditional advantages in processes of negotiation and accommodation with policy-makers to achieve tangible and positional gains in compensation for symbolic losses; and (in the case of the conflict in Ontario) it demonstrates the susceptibility of such negotiations over symbolic values to problems of misperception, miscalculation and "face." In longer-term perspective, moreover, the extra-billing issue is best understood as an episode of conflict in a long history of accommodation between medicine and the state under comprehensive medicare.

This paper presents the methodology and some preliminary findings from an ongoing study of the procedural rationality of regulatory decisionmaking in the occupational health arena. The author employs the concept of procedural rationality in the sense used by Herbert Simon to refer to the logic of decision‐making as it is shaped by institutional constraints. Of particular interest here is the impact of provisions for the involvement of affected interests in and public scrutiny of the regulatory process. The methodology presented involves a charting of the "decision frameworks" adopted by participants in the process at various stages. The methodology is illustrated through its application to the particular case of the development of a regulation governing occupational exposure to inorganic lead in the Canadian province of Ontario.

For over a decade, a major theme in the literature of social science has been the recognition of the increasing importance of specialized knowledge as a basis of power and wealth in modern societies. A fundamental question for political science hence becomes: how can we best understand the nature of the institutions which govern the acquisition and the application of specialized knowledge? What conceptual tools allow us to analyse the functioning of these institutions at present and to predict their future evolution?

Self-governing professions possess the authority, delegated by the state, to prescribe & police the rules governing the acquisition & exercise of particular types of skill. Political scientists have argued that this delegation of state authority creates "private governments," & have focused attention upon the internal political processes of professional organizations & upon the mechanisms of their external accountability. It is argued here, however, that the political issues raised by the existence of self-governing professions are considerably broader, & that a concept of "property" is more appropriate to the analysis of these issues than is a concept of private government. Professions have established property rights in their respective skills. The system of property in the professional case bears analogy with medieval institutions -- professional property rights are exclusive, conditional upon the fulfillment of social responsibilities, & more corporate than individual in nature. The rise of a highly interdependent technology & a welfare state is forcing a broadening of the interpretation of the social responsibilities of the professions to take into account their impact upon the distribution of technological & financial resources, & is leading to a recovery of a concept of property, not only as an exclusive right, but as a right of access to productive resources. These changes in turn are leading the state toward an increased role in the governance of professional skill & in the securing of individual rights against the corporate power of professions. As this process continues, the state may be brought to treat professional property as "public," & to manage it in either a technocratic or a democratic socialist mode. Recent government policy initiatives in Ontario & Quebec show the influence of these forces; they also, however, reveal the influence of a governmental system that is highly respectful of corporate property rights & of specialized expertise. AA.

Cover -- Contents -- Preface -- Contributors -- I: Introduction -- 1. Regions, Resources, and Resiliency: Introduction and Overview -- II: Regions and Resources: Setting the Stage -- 2. Go with the Flow: The (Im)plausibility of a Grand Canadian Intergovernmental Bargain on Energy Policy and Strategy -- 3. Terms-of-Trade Changes, the Dutch Disease, and Canadian Provincial Disparity -- III: Energy and Equalization -- 4. A National Energy Strategy for Canada: Golden Age or Golden Cage of Energy Federalism? -- 5. Surplus Recycling and the Canadian Federation: The Horizontal Fiscal Balance Dimension -- 6. Equalization and the Politics of Natural Resources: Balancing Provincial Autonomy and Territorial Solidarity -- IV: Resources and Resiliency: Institutional Considerations -- 7. Comparing Intergovernmental Institutions in Human Capital Development -- 8. Le Gouvernement régional d'Eeyou Istchee-Baie-James : une forme novatrice de gouvernance consensuelle au Canada -- 9. The Politics of Regions and Resources in Australia -- V: Identity and Resiliency -- 10. Guarding the Nation: Reconfiguring Canada in an Era of Neo-Conservatism -- 11. Being Canadian Today: Images in a Fractured Mirror.