New Public Governance in health care: Health Technology Assessment for Canadian pharmaceuticals

The New Public Governance (NPG) paradigm addresses problems of complex and fragmented policy-making. Health care is an increasingly complex policy area, and Canada has one of the most fragmented health care systems in the world. The theoretical articulation of NPG is compelling, and seems well suited to Canadian health care. However, it is not clear how these concepts could be applied to health care. We use the case of Health Technology Assessment (HTA) to evaluate the opportunities and limitations of NPG within a specific health care context. We argue that the kind of governance recommended by NPG has contributed to the development and integration of HTA in Canada. However, we note that this kind of governance structure may be limited to certain instances, and we describe the conditions under which horizontal governance structures in HTA were able to flourish.