Placement: Mailman School of Public Health, Columbia University
Mentor: Michael. S. Sparer, Chair and Professor, Health Policy and Management
Co-mentor: Christopher F. Koller, President and Rachel Block, Program Officer, Milbank Memorial Fund
Project: Intergovernmental Relations and Healthcare Reform: A Qualitative Case Study Exploring the Dynamics of Federalism in the State Innovation Model Initiative
Anne-marie Boxall, M.P.H. (Hons.), Ph.D., is a 2019–20 Australian Harkness Fellow in Health Care Policy and Practice. As assistant secretary, Long-term Health Reform Branch, with the Australian Government Department of Health, Boxall has led development of policy to support long-term health system reform in Australia and has been extensively involved in negotiating the 2020–2025 National Health Reform Agreement with states and territories. Her experience in intergovernmental relations in Australia has been the stimulus for her Harkness Fellowship project in the United States. Boxall has worked in government, nongovernment, and academic sectors. She is an adjunct associate professor with the Menzies Centre for Health Policy at the University of Sydney and has published on a wide range of health policy topics for academic and nonacademic audiences, including Making Medicare: The Politics of Universal Health Care in Australia (2013), which she co-authored with James Gillespie. Boxall received her M.P.H. with Honors and her Ph.D. in health policy from the University of Sydney.
Project Overview: The United States, like Australia, is organized as a federal system. The way federalism works in practice has a major impact on health policymaking in both countries. In the United States, the Patient Protection and Affordable Care Act has disturbed an uneasy truce between the national government and the states, making highly relevant a study of intergovernmental relations in health care reform. This study examines collaborations between federal and state bureaucrats and their impact on the diffusion of policy innovations across states. It aims to explore the interactions between state and federal government officials during the design, implementation, and review phases of the Center for Medicare and Medicaid Innovation (CMMI) State Innovation Models (SIM) initiative.
Under the SIM initiative, the federal government partners with states to advance health payment and service delivery reforms. The overarching goal of this study is to identify what helps and hinders reform in individual states and knowledge transfer between governments about reform implementation. Methodology will consist of case studies in select states that have participated in the SIM initiative. The study will collect qualitative data through document analysis and interviews with key informants, including senior state and federal health policymakers. This study of the U.S. will be particularly relevant to Australia, where analyses of federalism and its implications for health policymaking are underdeveloped. In practice, there are many well-established, formal intergovernmental fora in the health sector, but there is considerable scope to develop stronger partnerships between levels of government in order to promote policy learning.
Current Position:
- Chief Allied Health Officer, Commonwealth Department of Health
