INSTITUTIONS, INSTITUTIONALIZED NETWORKS AND POLICY CHOICES - HEALTH-POLICY IN THE US AND CANADA

This article uses the case of health insurance policy in the United St ates and Canada, to try to explain how particular state-societal patte rns of intermediation unfold, become institutionalized and effect quit e different policy strategies. It begins by outlining the importance o f formal political and administrative institutional structure in the e xercise of autonomous state action. It then examines the concepts of p olicy community and policy network as state-specific vehicles of inter est intermediation and finally, it grounds the theoretical discussion in a comparative description of the evolution of health policy in the United Stares and Canada. It concludes that to a great extent, we are the prisoners of our institutions-both political and societal-and with out fundamental change, necessitating major upheaval, the United State s is unlikely to embrace a national health insurance program similar t o other western nations.