| Chapter 1: | Examining Provincial Variability |
In addition, we posit that as financial pressures increase both in the Canadian health care system and in other areas seeking federal financial assistance, over time the desire to maintain access within the health care system leads to relationships with private investors and business interests, as well as private market models within the framework of Canada’s medicare system. We focus primarily on recent public–private sector developments, often of a for-profit nature (Minow 2003), in provincial health care delivery systems. Around the world, many national health insurance plans incorporate a mixed public and private health care delivery system, though such mixes of for-profit and not-for-profit service providers vary according to the ideological, political, cultural, and historical characteristics of the nations in question (Blank and Burau 2004; Forest and Bergeron 2005; Nathanson 2007; Palley, Pomey, and Forest 2011
A recent review of the comparative policy analysis and health care offers no systematic approach to such studies (Marmor, Freeman, and Okma 2009, 1–23); in this collection, Carolyn Hughes Tuohy provided a theoretical perspective for understanding change or the lack thereof regarding federal and provincial events in health policies in Canada. She designated two dimensions of the factors involved in producing change or resisting change: an institutional mix and a structural balance. Tuohy defined institutional mix as “the mix of hierarchy, market and collegiality (peer control) in the design of decision-making structures,” and structural balance as the balance of influence across “state actors, health care providers, and private financial interests” (Tuohy 2009b, 62–63). Our simpler model encompasses all of Tuohy’s factors. Further, in developing our analysis, we used pertinent documents (e.g., governmental reports from provincial and federal levels, judicial cases, newspaper and TV accounts), as well as semistructured interviews.