Why has health care reform proved a stumbling block for provincial governments across Canada? What efforts have been made to improve a struggling system, and how have they succeeded or failed? In Paradigm Freeze, experts in the field answer these fundamental questions by examining and comparing six essential policy issues - regionalization, needs-based funding, alternative payment plans, privatization, waiting lists, and prescription drug coverage - in five provinces. Noting hundreds of recommendations from dozens of reports commissioned by provincial governments over the last quarter century - the great majority to little or no avail - the book focuses on careful diagnosis, rather than unplanned treatment, of the problem. Paradigm Freeze is based on thirty case studies of policy reform in Alberta, Saskatchewan, Ontario, Quebec, and Newfoundland and Labrador. The contributors assess the nature and extent of healthcare reform in Canada since the beginning of the 1990s. They account for the generally limited extent of reform that has occurred, and identify the factors associated with the relatively few cases of large reform. An insightful new perspective on a problem that has plagued Canadian governments for decades, Paradigm Freeze is an important addition to the field of health policy. Contributors include John Church (University of Alberta), Michael Ducie (Alberta Health and Wellness), Pierre-Gerlier Forest (Pierre Elliott Trudeau Foundation), Stephen Tomblin (Memorial University), Jeff Braun Jackson (Ontario Professional Firefighters Association, Burlington, ON), Marie-Pascale Pomey (Universite de Montreal), John N. Lavis (McMaster University), Harvey Lazar (Queen's University), Elisabeth Martin (Universite Laval),Tom McIntosh (University of Regina), Dianna Pasic (McMaster University), Neale Smith (University of British Columbia), and Michael G. Wilson (McMaster University).

Local governments are becoming increasingly important around the world and functions are being shifted across levels of government. This timely comparative analysis breaks new ground in the study of multilevel governance, intergovernmental relations, and municipal government. Spheres of Governance systematically compares the challenges faced by municipalities in Australia, France, Germany, Mexico, South Africa, Spain, Switzerland, and the United States, with emphasis on the relationship between the municipal and federal levels. Each chapter analyzes a municipality in relation to its responsibilities, functions, and organization; constitutional and fiscal position; relations with the central government; provincial and state governments mediation of these relationships; and public policy development, especially with regard to emergency planning and immigration and settlement. The chapters also highlight the tensions and pressures for change in the systems.