Accidental Logics The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada

by Tuohy, Carolyn Hughes

• ISBN13: 9780195128215
• ISBN10: 0195128214
• Format: Hardcover
• Copyright: 1999-05-20
• Publisher: Oxford University Press

Summary

What drives change in health care systems? Why do certain changes occur insome nations and not in others? Author Carolyn Hughes Tuohy argues that theanswer lies in understanding the "accidents" of history that have shapednational systems at critical moments, and in the distinctive "logics" of thesesystems. Tuohy looks at the experiences of Britain, Canada, and the US, offeringan international comparative study of public policy systems, as well as a recenthistory of the circumstances in each country that have impacted on thestructures of each's national health care system. The guiding focus of the bookis Tuohy's study of decision-making systems in each country, looking at thedecisions made by those who provide, finance, and use health care services.Finally, Tuohy reviews current issues in the health care arenas of these threenations and provides suggestions to guide the strategic judgments thatdecision-makers must make.

Table of Contents

Understanding the Dynamics of Change in the Health Care Arena	3	(34)
The Conceptual Framework: The Accidental Logics of Change in Policy Arenas	6	(3)
Dimensions of Decision-Making Systems: Institutional Mix and Structural Balance	9	(2)
Policy Episodes and System Logics	11	(4)
The Economics of Health Care Delivery: Agency, Risk, and Localism	15	(4)
The Health Policy Agenda of the 1990s	19	(8)
Britain, the United States, and Canada	27	(10)
PART I. EPISODES OF POLICY CHANGE
The Establishment of the Welfare State in the Health Care Arena	37	(25)
The Immediate Postwar Period: Britain versus Canada and the United States	38	(9)
The 1950s and 1960s: The Establishment of Governmental Health Insurance in Canada and the United States	47	(15)
The Reforms of the 1990s	62	(45)
Britain	63	(8)
The United States	71	(18)
Canada	89	(18)
Institutions, Ideas, Interests, Actors, and the Accidents of Policy Episodes	107	(20)
Political Institutions	108	(4)
Policy Legacies and Path Dependency	112	(1)
Public Opinion and Cultural Understandings	113	(2)
Political Culture and Parties	115	(2)
Interests	117	(2)
Strategic Judgment	119	(4)
Understanding Policy Episodes	123	(4)
PART II. THE DISTINCTIVE LOGICS OF NATIONAL SYSTEMS
The United States: The Logic of the Mixed Market	127	(35)
Regulation in the 1970s	129	(2)
Prospective Payment in the 1980s	131	(2)
The Rise of ``Managed Care''	133	(3)
Regional versus National Markets	136	(2)
The Growing Role of For-Profits	138	(4)
Performance Monitoring and the Role of Clinical Judgment	142	(9)
Information and Information Technology	151	(2)
The Changing Political Terrain	153	(5)
Institutional and Structural Change in the Mixed Market	158	(1)
The Logic of Entrepreneurialism	159	(3)
Britain: The Logic of Corporatism Meets the Internal Market	162	(41)
Corporatism in the NHS	163	(2)
Managerialism and the Griffiths Reforms	165	(4)
The Purchaser-Provider Split: Bargaining in the Internal Market	169	(3)
Bargaining Roles: The Provider Side	172	(2)
Bargaining Roles: The Purchaser Side	174	(5)
Clinical Audit and the Role of Clinical Judgment	179	(4)
Information and Information Technology	183	(2)
The Role of the Private Sector	185	(6)
The Role of Partisan and Electoral Politics	191	(6)
Institutional and Structural Change in the Internal Market	197	(2)
The Logic of the Internal Market	199	(4)
Canada: The Logic of the Single-Payer System	203	(36)
The Founding Bargain: Fee-for-Service and the Negotiation of Price	204	(3)
Provincial-Level Accommodations in the 1970s and 1980s	207	(4)
Expenditure Caps in the 1990s	211	(5)
The Expanding Agenda	216	(8)
Information and Information Technology	224	(2)
Changing Profession--Government Relations and the Impact on Organized Medicine	226	(5)
The Logic of the Profession-State Accommodation	231	(3)
Institutional and Structural Change in a Single-Payer System	234	(5)
Conclusion	239	(30)
The Health Policy Arena in Britain, the United States, and Canada	239	(11)
Concluding Observations	250	(19)
Notes	269	(14)
References	283	(22)
Index	305