Health care entitlement and citizenship development: Re-evaluating the social rights thesis.
Date
2000
Authors
Redden, Candace Johnson.
Journal Title
Journal ISSN
Volume Title
Publisher
Dalhousie University
Abstract
Description
As provincial governments devise health care reform strategies to respond to the changing dynamics of budgeting, federalism, and health, citizens resist changes to what they perceive to be social rights of citizenship. Such resistance is beneficial in that it serves to protect entitlement to a range of services and secure health care as a symbol of national identity. However, the right to health care has been defended categorically as an infungible, sustainable element of the state-society relationship in spite of the evolutionary nature of citizenship. As the universal health care system developed throughout the 1940s, 50s and 60s, and the range of available services expanded, citizens' expectations were elevated. And by 1980, when retrenchment was imminent, health care had become a symbol of Canadian identity, and as such, a politically charged policy field. The political potency of health care has proven to be a serious constraint to change at a time when decision-making for health care requires dynamism and flexibility, rather than stability and stasis. Further, the analysis presented indicates that Canada has entered a new stage of citizenship development. Continued defences of the right to health care cannot by themselves secure access and entitlement for all Canadians. What is needed, instead, is recognition of the multiplicity of differentiated citizenship claims across the country, an understanding of how those claims can be expressed and accommodated in public policy, and a strategy for identity-based communities informing and interacting with geographically-based entities.
The challenge for health care reformers, then, is to attenuate stasis, and, at the same time, protect entitlement. The analysis of this dissertation provides some foundational support for understanding the right to health care and the need for policy change. Paradoxically, it seems that the former precludes the latter. Patterns of entitlement often protect the very models or components of the system that are in serious need of reevaluation. This is not to say that the problem is one of dichotomous choosing between universal public provision and privatization. Epidemiological, technological and political patterns indicate a far more sophisticated and irresolvable conundrum of balancing individual responsibility-taking with collective entitlement.
Thesis (Ph.D.)--Dalhousie University (Canada), 2000.
The challenge for health care reformers, then, is to attenuate stasis, and, at the same time, protect entitlement. The analysis of this dissertation provides some foundational support for understanding the right to health care and the need for policy change. Paradoxically, it seems that the former precludes the latter. Patterns of entitlement often protect the very models or components of the system that are in serious need of reevaluation. This is not to say that the problem is one of dichotomous choosing between universal public provision and privatization. Epidemiological, technological and political patterns indicate a far more sophisticated and irresolvable conundrum of balancing individual responsibility-taking with collective entitlement.
Thesis (Ph.D.)--Dalhousie University (Canada), 2000.
Keywords
Political Science, General., Health Sciences, Health Care Management.