9780195128215

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

by
  • ISBN13:

    9780195128215

  • ISBN10:

    0195128214

  • Format: Hardcover
  • Copyright: 1999-05-20
  • Publisher: Oxford University Press

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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

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