Accidental Logics: The Dynamics of Change in the Health Care by Carolyn Hughes Tuohy

By Carolyn Hughes Tuohy

What drives swap in healthiness care platforms? Why do sure alterations happen in a few countries and never in others? writer Carolyn Hughes Tuohy argues that the reply lies in knowing the "accidents" of heritage that experience formed nationwide structures at severe moments, and within the targeted "logics" of those platforms. Tuohy seems to be on the studies of england, Canada, and the united states, providing a global comparative research of public coverage platforms, in addition to a contemporary historical past of the conditions in each one nation that experience impacted at the buildings of each's nationwide health and wellbeing care method. The guiding concentration of the booklet is Tuohy's research of determination making platforms in every one state, the selections made via those that supply, finance, and use wellbeing and fitness care providers. eventually, Tuohy reports present concerns within the well-being care arenas of those 3 international locations and offers feedback to lead the strategic judgments that decision-makers needs to make.

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

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In the first place, they share a broadly similar tradition of state—society relations which, among other things, implies an autonomous base for professions vis-a-vis the state, in contrast to the more "statist" or "state-corporatist" model of continental Europe (Rueschemeyer 1986; Stone 1977: 38-39). They also share a roughly similar structure for the organization of capital, with a distinction between "real" and "financial" capital and a heavy reliance on equity markets, again in contrast to a more integrated continental European model (Zysman 1983; Hall 1986: 229—83).

This paradigm is a response to the mirror weaknesses inherent in the "old" opposing paradigms of state-driven systems on the one hand and market-driven systems on the other. Under a hierarchical state system, quintessentially represented by the British National Health Sevice (NHS) prior to 1990, all three functions were combined, and the incentives to innovation and efficiency associated with the market were allegedly lacking. Under traditional market-driven systems of medical insurance in which third-party payers played a more or less passive financing role, the three functions were completely separated, and those making the actual purchasing decisions were individuals lacking the resources to make sophisticated decisions.

But in general this phenomenon represented a significant transforma- Understanding the Dynamics of Change in the Health Care Arena 27 tion, if not a supplantation, of the model of decision-making that had prevailed in the past. The emergence of these bargaining relationships represented change, to different degrees in different nations, in the structural balance and institutional mix of the health care arena. This book explores those changes (or lack thereof) in three nations in particular. Britain, the United States, and Canada provide not only three different structural and institutional models—approximating very roughly the ideal types of state hierarchy, private market, and professional collegiality—but they also evince very different histories of change in the 1990s.

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