Katherine Boothe’s broad research interest is in the qualitative study of variation in health and social policies: why do jurisdictions choose different responses to similar policy problems, and what opportunities and challenges do these different policies present for reform?


Boothe’s current research examines the adoption and reform of drug assessment and reimbursement policies in Canada and internationally. This research is concerned with changing conceptions of legitimacy as they relate to rationing of public health resources. Specifically, it investigates the processes of health technology assessment (HTA) that many public drug plans use to determine which pharmaceutical products are eligible for public funding, and the expansion of public and patient involvement in HTA in Canada since the early 2000s. More information for research participants (password protected link).


Boothe’s 2015 University of Toronto Press book, Ideas and the Pace of Change, compares the development or non-development of nation-wide pharmaceutical insurance in Canada, the UK, and Australia, in order to explain why Canada is the only mature welfare state that does not provide broad public coverage for drugs. Dr. Danielle Martin reviewed the book in the Literary Review of Canada, saying that it “addresses an issue that should concern us all. We have a drug problem in Canada: a problem of high prices, poor access and variable quality of prescribing. Change is needed.”


Boothe was an expert witness at the Parliamentary Standing Committee on Health’s 2016 hearings on national pharmacare in Canada, participated in consultations for the 2019 Advisory Committee on the Implementation of National Pharmacare, and has published a number of op-eds on pharmacare in Canada. Links to News page?


  • Ideas and the pace of change:

    national pharmaceutical insurance in Canada, Australia, and the United Kingdom

    Katherine Boothe

    Toronto: University of Toronto Press


  • "Getting to the table":

    Changing ideas about public and patient involvement in Canadian drug assessment.”

    Katherine Boothe

    Journal of Health Politics, Policy and Law 44 (4): 631-663.



    "Pharmaceutical policy reform in Canada: lessons from history.”

    Katherine Boothe

    Health Economics, Policy and Law. 13 (3-4):299-322


  • “Universal prescription drug coverage in Canada: long-promised yet undelivered.”

    Steve Morgan & Katherine Boothe

    Joint Issue of Healthcare Management Forum (Canada) and Health Services Management Research (Europe) 29(6):247-254


  • “Evaluating the cost-effectiveness of pharmaceuticals in Canada.”

    Katherine Boothe

    Health Reform Observer. 14(1): 1-20


  • “Ideas and the limits on program expansion: the failure of nation-wide pharmacare in Canada, 1944-2002.”

    Katherine Boothe

    Canadian Journal of Political Science 46(2): 419-453


  • “How the pace of change affects the scope of reform: pharmaceutical insurance in Canada, Australia and the UK.”

    Katherine Boothe

    Journal of Health Politics, Policy and Law 37(5): 779-814




Canada is the only OECD country that has universal, comprehensive public hospital and medical insurance but lacks equivalent pharmaceutical coverage. In Ideas and the Pace of Change, Katherine Boothe explains the reasons for this unique situation. Using archival, interview, and polling data, Boothe compares the policy histories of Canada, the United Kingdom, and Australia in order to understand why Canada followed a different path on pharmaceutical insurance.

Boothe argues that pace matters in policy change. Quick, radical change requires centralized political institutions, an elite consensus, and an engaged, attentive electorate. Without these prerequisites, states are far more likely to take a slower, incremental approach. But while rapid policy change reinforces the new consensus, incremental progress strengthens the status quo, letting development stall and raising the bar for achieving change.

An important contribution to the study of comparative political economy, Ideas and the Pace of Change should be required reading for anyone seeking to understand why health care reforms succeed or fail.




  • Public policy

  • Comparative politics

  • Canadian politics

  • Social and health policy

  • Patient involvement in healthcare

  • Pharmaceutical policy




© 2020 Katherine Boothe