The Political and Economic Sustainability of Health Care in Canad ...

governments’ political dispositions to act—that is, factors related to political leadership and political and economic sustainability issues (Heisler and Peters 1977; Nathanson 2007; also see Brown 1998; Marse and Paulus 2003; Ramsay 2004 ; Wessen 1999). The political scientists Martin O. Heisler and Guy B. Peters have also noted that existential factors—such as perceived needs, availability of resources, and the presence of a political window of opportunity—may affect policy development in the areas of health and social welfare (1977). Whereas Heisler and Peters developed a multidimensional approach to public policy decision making with respect to Canadian health care delivery decisions, our study postulates that perceived needs and perceived resource limitations are important factors affecting economic and political sustainability. Judgements regarding political and economic sustainability are important drivers leading to an increase in the number of for-profit organizations and in their participation in Canada’s health care system. Heisler and Peters presented a theoretical perspective maintaining that social policies result from a multitude of variables, including governmental structure, political factors, available resources, and agency (the political disposition of political officeholders to act). A somewhat similar multifactor approach specifically focusing on health care delivery is presented in the work of Blank and Burau (2004). Recent collections by Marmor, Freeman, and Okma (2009) and Okma and Crivelli (2010) also examine the multiplicity of factors involved in national health policy reforms.

We utilize a comparative perspective because the shaping of the health care delivery system and the implementation of health care services in Canada is primarily the responsibility of provinces that are diverse in a number of respects. Further, the accumulation of national studies using a comparative framework has contributed to the comparative policy literature (See Heisler and Peters 1977; Kervasdoué, Kimberly, and Rodwin 1984; Okma and Crivelli, 2010; Dutton 2007; Marmor, Freeman, and Okma, 2009). Similarly, a comparative approach to subnational studies adds to this comparative knowledge (Altenstetter 1978; Forest and Bergeron 2005; Imbeau et al., 2001; and Tuohy 2009b).