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Abstract Health policy changes intended to achieve cost control in OECD countries run the risk of reintroducing financial barriers to health care. However, although the problems faced are similar, different countries are dealing with the situation in different ways. For example, Canada and Australia, which share many similarities, have taken quite different policy paths in the last decade: Canada has preserved universal access, whereas Australian policy is promoting a two-tier system through the provision of public subsidies for private insurance. The evidence is that country-- specific factors such as institutional arrangements, attitudes, and values intersect with economic and financial factors to shape policy outcomes. Moreover, the Canadian and Australian experiences suggest that in relation to access issues, attitudes and values are the key policy determinants.
Current health policy developments in industrialized countries are raising the prospect of reintroducing financial obstacles to medical care. In the search for mechanisms to control cost increases, governments are experimenting with forms of privatization, including demand-side instruments. Many of these mechanisms have the potential to seriously constrain use of medical services. However, not all countries are choosing the same approach to the problems of cost control. Despite the similarity of the pressures faced, policy outcomes differ significantly between nations. Canada and Australia, for example, are two countries that, while they share many similarities, have experienced divergent policy paths in the last decade: although Canada has preserved universal access to medical care, access has been eroded in Australia. A study of policy in the two countries suggests that "local" factors, such as institutional arrangements, attitudes, and values, as they intersect with economic and financial factors, are key determinants of the shape of policy outcomes. This finding is consistent with recent evidence from social policy developments in the European Union: different socioeconomic conditions, combined with differing political ideologies and ideas about the legitimacy of state intervention, have been found to account for different solutions to similar problems. In the case of access to health care, however, Canadian and Australian experience suggests that attitudes and values are the key factors in determining whether universal access will be preserved.
Financial barriers, of course, are not the only reasons why people might be deterred from using medical services. As feminists and others have pointed...