The Form and Context of Federalism: Meanings for Health Care Financing

Abstract This article examines the meaning of federalism for health care financing (HCF) and is based on two considerations. First, federal institutions are embedded in their national context and interact with them. The design and performance of HCF policy will be influenced by contexts, the workings of the federal institutions, and the interactions of these institutions with different elements of the context. This article unravels these influences. Second, there is no unique model of federalism, and so we have to specify the particular form to which we refer. The examination of the influ-ence of federalism and its context on HCF policy is facilitated by using a transnational comparative approach, and this article examines four mature federations: the Unite