The hospitals of Canada and the United States: From the beginning to 1965

Throughout the nineteenth and twentieth centuries voluntary, non profit organizations have been owned and managed most general hospitals in Canada and the United States. This dissertation reviews the historical development of public financing and supervision of voluntary hospitals in North America before World War II and relates these cross-national differences to postwar innovations in hospital financing in Canada and the United States. The contention is that provincial governments championed hospital policies in the prewar era which presaged the emergence of universal hospital insurance in Canada in the 1940s and 50s. Whereas provincial governments provided an anchor for the implementation of a national hospital insurance program, American state governments abdicated responsibility for public financing of hospital care to local and then federal governments, resulting in the creation of Medicare and Medicaid programs for the elderly and the poor in the 1960s.; Students of comparative politics have offered a number of explanations for the historical branching of health insurance strategies in Canada and the United States. These interpretations draw upon a many theoretical traditions and privilege a variety explanatory variables--political culture, working-class mobilization, interest group politics, etc. This study reviews the leading interpretative frameworks advanced thus far to account for the variance in American and Canadian health care policies and offers an alternative perspective, a policy paradigm approach.; Policy paradigms refer to socially constructed logics of governmental authority. Governments choose among policy options as they do because policy cultures provide legislators with ideological justifications and rationales for some things and not others. The dissertation's findings about the origins of national hospital insurance strategies suggest that a paradigms approach to historical and contemporary policy debates offers the more comprehensive account of hospital organization and finance in the North American democracies.