Pharmaceutical benefits in time: the puzzle of Canadian distinctiveness.

Although Canada prides itself on its universal and comprehensive public health insurance system, is the only country that provides widespread public health benefits but does not provide similar pharmaceutical benefits. This presents both an empirical puzzle and a theoretical challenge, which cannot be accounted for by the literature on variation among national health insurance systems. Canada's outlier status suggests that pharmaceutical benefits cannot simply be subsumed into health insurance policy, and more generally, that closely related aspects of social policy might be subject to quite different dynamics. In this paper, I demonstrate that Canada's failure to provide nation-wide public coverage of pharmaceuticals is a product of its earliest decisions about how to approach health policy, and that over time, ideas and public expectations interact to set strict limits on the opportunities for policy development. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]