By Carolyn Hughes Tuohy
What drives switch in overall healthiness care structures? Why do sure alterations ensue in a few international locations and never in others? writer Carolyn Hughes Tuohy argues that the reply lies in figuring out the "accidents" of heritage that experience formed nationwide structures at serious moments, and within the exact "logics" of those structures. Tuohy seems to be on the reviews of england, Canada, and the USA, supplying a world comparative learn of public coverage structures, in addition to a contemporary historical past of the situations in every 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 learn of choice making structures in each one kingdom, taking a look at the choices made through those that supply, finance, and use future health care prone. eventually, Tuohy studies present concerns within the healthiness care arenas of those 3 international locations and offers feedback to steer the strategic judgments that decision-makers needs to make.
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Additional resources for Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada
In Scandinavia, collegial elements were retained within the state system, and the effect of the growing role of the state was not so much to constrain the exercise of professional influence as it was to shift the balance of power within the medical profession itself (Erichsen 1995). In Spain, on the other hand, reforms in the 1980s that drew the system closer to the state hierarchical model reduced substantially the role of professional bodi and the influence of the medical profession (Rodriguez 1995:156-58).
Within broad budgetary parameters established by provincial governments, physicians have been central to decision-making systems at various levels from central joint profession-government "management" committees at the provincial level, to the level of autonomously constituted hospital medical staffs, to the level of independent individual medical practices. Professionally dominated collegial mechanisms, that is, not only survived the introduction of state-sponsored health insurance, but they were also reinforced Understanding the Dynamics of Change in the Health Care Arena 31 and supplemented by other mechanisms.
Second, the state could seek to regulate providers, establishing rules to gov- Understanding the Dynamics of Change in the Health Care Arena 17 em behavior—an essentially hierarchical response. Cross-nationally, physicians are indeed subject to the control of state-sanctioned regulatory bodies. But state actors themselves face information gaps in regulating the behavior of professional groups such as physicians. Accordingly a third way—which in fact characterizes most state-sanctioned systems for the regulation of medical professionals—is self-regulation: placing the control of medical behavior essentially in the hands of the professional group itself.