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Roadblocks to Reform: Beyond the Usual Suspects


  • Grignon Michel

    () (Department of Economics, Centre for Health Economics and Policy Analysis, McMaster University)


Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered for why such reforms are so difficult: institutional gridlock, path dependency and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that, as a result, public resistance to real reform may more accurately reflect citizensÕ personal convictions, self-interest or even active social choices. ÒConscientious objectorsÓ may do more to derail reform than previously recognized.

Suggested Citation

  • Grignon Michel, 2012. "Roadblocks to Reform: Beyond the Usual Suspects," Centre for Health Economics and Policy Analysis Working Paper Series 2012-01, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
  • Handle: RePEc:hpa:wpaper:201201

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    References listed on IDEAS

    1. Jacob, Johanna & Lundin, Douglas, 2005. "A median voter model of health insurance with ex post moral hazard," Journal of Health Economics, Elsevier, vol. 24(2), pages 407-426, March.
    2. Abelson, Julia & Miller, Fiona A. & Giacomini, Mita, 2009. "What does it mean to trust a health system?: A qualitative study of Canadian health care values," Health Policy, Elsevier, vol. 91(1), pages 63-70, June.
    3. Thomasson, Melissa A., 2002. "From Sickness to Health: The Twentieth-Century Development of U.S. Health Insurance," Explorations in Economic History, Elsevier, vol. 39(3), pages 233-253, July.
    4. Kenworthy, Lane, 2000. "Quantitative indicators of corporatism: A survey and assessment," MPIfG Discussion Paper 00/4, Max Planck Institute for the Study of Societies.
    5. Light, Donald W., 2011. "Historical and comparative reflections on the U.S. national health insurance reforms," Social Science & Medicine, Elsevier, vol. 72(2), pages 129-132, January.
    6. Michel Grignon, 2009. "Pourquoi les systèmes de santé sont-ils organisés différemment ?," Revue économique, Presses de Sciences-Po, vol. 60(2), pages 545-558.
    7. Miguel Gouveia, 1997. "Majority rule and the public provision of a private good," Public Choice, Springer, vol. 93(3), pages 221-244, December.
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