Health Care and Federalism

This comparative program examines the division of responsibilities, funding mechanisms and means of cooperation between levels of government to ensure equity, access, quality and efficiency of health care in federal systems. It looks at which order of government has constitutional and legal responsibility for health and healthcare and whether responsibility for healthcare is explicitly assigned to one or the other order of government, or both orders of government. It describe the range of decision space choices (narrow, moderate, broad) in terms of governance rules, access rules, health human resources, health care organizations and financing and investigates what are the capacities of the subnational governments and delegated health authorities at the subnational level and whether subnational capacities differ markedly from central government capacity.

The objectives of the program are to deepen knowledge on the issue and to draw out lessons for emerging federations. The program will cover the following case studies: Canada, Switzerland or Germany, Spain, Mexico, Brazil, India, Nigeria, and South Africa. The program is coordinated by two lead experts: Dr. Greg Marchildon, Canada Research Chair in Public Policy and Economic History, University of Regina; and Dr. Thomas Bossert, Lecturer on Global Health Policy, Harvard School of Public Health.

For further inquiries please contact Diana Chebenova at Chebenova@forumfed.org