Federalism, Physicians, and Public Policy: A Comparison of Health Care Reform in Canada and Brazil

This article uses comparative historical analysis to explore physicians' involvement in health care reform in Canada and Brazil. Drawing on historical institutionalism, the analysis stresses how, beyond partisanship, physicians build consensus around and promote specific policy ideas, and how federal institutions shape physicians' mobilization. In both countries, physicians' mobilization shaped the emergence of universal health care coverage, but in quite different ways, because of the differing federal institutions. Although the Brazilian medical lobby was far more heterogeneous than the Canadian profession, one faction was able to mobilize at the local level to pursue policy ideas favorable to universal health coverage.