What prompts health care policy change? On political power contests and reform of health care systems (the case of Canada and Israel).

This article attempts to shed light on the complexity inherent in health care reform policies in the context of political power contests that trigger the changes imposed on the health care system. Rather than being solely a response to financial circumstances, as it is often claimed, we argue that these political contests lead to many of the changes in the systems. Furthermore, changes do not necessarily occur when worrying symptoms appear in the system, but rather when the contest reaches a peak and when neither side involved can emerge from the contest as winner or loser and as defender of the public interest. While in both cases fiscal problems in the health systems are usually brought up in order to justify reform, the trigger for change in Israel has been the power contest between the two main parties--the Labor Party and the Likud Party--with the Likud attempting to impair the financial basis of the former. In Canada, the power contests are between the provinces and the federal government.