THE MAKING OF NATIONAL-HEALTH INSURANCE IN BRITAIN AND CANADA - INSTITUTIONAL ANALYSIS AND ITS LIMITS

Scholars examining the development of health insurance reform programs from an institutionalist perspective have drawn attention to the impo rtance of state structures and administrative capacities in shaping so cial policy outcomes. Focusing on the introduction of the British Nati onal Health Insurance Act of 1911 and the Canadian Hospital Insurance Act of 1957, I suggest that institutionalist analysis can obscure the historical record in three ways. Analysts may ignore the multiple inst itutional mechanisms that were available to policy makers at the time; they may overlook the contentiousness of policy battles; and they may underestimate the extent to which similar institutions have functione d in very different ways. In the case of Britain, I argue that nationa l health insurance was part of a package of social reforms designed to halt the slide of Britain from a position of preeminence in the world economy. The introduction of Canadian health insurance coincided with an increased role for local and federal states in fostering economic development within the nation. Institutional structures, cultural valu es, and political power were all resources used within both states to create a consensus behind the new national agenda.