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Accidental Logics : the Dyn...

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

Oxford University Press, USA 1999

Health care reform has become one of the most prevalent topics in recent policy discourse within and across nations. In the 1990s, common features of the health care arena elevated the importance of bargaining relationships among large, sophisticated entities as the dominant mode of decision-making, fundamentally challenging the traditional dominance of the medical profession, which had been grounded in individualized "agency" relationships between providers and patients. These developments have played out in varying ways around the globe. Carolyn Hughes Tuohy looks at the experiences of the United States, Britain, and Canada, offering an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. L What drives change in health care systems? Why do certain changes occur in some nations and not in others? Tuohy argues that the answer lies in understanding the "accidents" of history that have shaped national systems at critical moments and in the distinctive "logics" of these systems.; Her study carefully delineates both the common logic of the health care arena, deriving from micro-economic characteristics and technological change, and the particular logics of national systems, put in place by specific episodes of policy change. She goes on to explore how in the wake of these episodes, the mixed market in the United States, hierarchical corporatism in Britain, and the single-payer system in Canada determined the subsequent direction and pace of change in all three countries. Finally, Tuohy provides suggestions to guide the strategic judgments that decision-makers must make within the health care system of each country. Accidental Logics uniquely departs from the descriptive literature currently available by presenting an extensive review of the evidence regarding the evolution of the health care arenas in the United States, Britain, and Canada, integrated within an explanatory framework. It is essential up-to-date reading for political scientists working in comparative politics and public policy, health policy analysts, government agency officials, and students in political science, health policy, and administration programs

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monografia Rebiun22455619 https://catalogo.rebiun.org/rebiun/record/Rebiun22455619 m o d cr un|---uuuuu 121028s1999 xx ob 001 0 eng d 778206623 814459175 821693561 1280530421 9781280530425 0195128214 alk. paper) IDEBK eng pn IDEBK OCLCQ EBLCP OCLCQ MERUC ZCU U3W OCLCO OCLCF ICG AU@ OCLCQ DKC OCLCQ n-cn--- e-uk--- n-us--- MBNH bicssc Accidental Logics the Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada Oxford University Press, USA 1999 Oxford University Press, USA 1 online resource 1 online resource Text txt rdacontent computer c rdamedia online resource cr rdacarrier Includes bibliographical references (pages 283-304) and index 1. Understanding the Dynamics of Change in the Health Care Arena -- The Conceptual Framework: The Accidental Logics of Change in Policy Arenas -- Dimensions of Decision-Making Systems: Institutional Mix and Structural Balance -- Policy Episodes and System Logics -- The Economics of Health Care Delivery: Agency, Risk, and Localism -- The Health Policy Agenda of the 1990s -- Britain, the United States, and Canada -- PART I. EPISODES OF POLICY CHANGE -- 2. The Establishment of the Welfare State in the Health Care Arena The Immediate Postwar Period: Britain versus Canada and the United States -- The 1950s and 1960s: The Establishment of Governmental Health Insurance in Canada and the United States -- 3. The Reforms of the 1990s -- Britain -- The United States -- Canada -- 4. Institutions, Ideas, Interests, Actors, and the Accidents of Policy Episodes -- Political Institutions -- Policy Legacies and Path Dependency -- Public Opinion and Cultural Understandings -- Political Culture and Parties -- Interests -- Strategic Judgment -- Understanding Policy Episodes -- PART II. THE DISTINCTIVE LOGICS OF NATIONAL SYSTEMS 5. The United States: The Logic of the Mixed Market -- Regulation in the 1970s -- Prospective Payment in the 1980s -- The Rise of ""Managed Care"" -- Regional versus National Markets -- The Growing Role of For-Profits -- Performance Monitoring and the Role of Clinical Judgment -- Information and Information Technology -- The Changing Political Terrain -- Institutional and Structural Change in the Mixed Market -- The Logic of Entrepreneurialism -- 6. Britain: The Logic of Corporatism Meets the Internal Market -- Corporatism in the NHS -- Managerialism and the Griffiths Reforms The Purchaser-Provider Split: Bargaining in the Internal Market -- Bargaining Roles: The Provider Side -- Bargaining Roles: The Purchaser Side -- Clinical Audit and the Role of Clinical Judgment -- Information and Information Technology -- The Role of the Private Sector -- The Role of Partisan and Electoral Politics -- Institutional and Structural Change in the Internal Market -- The Logic of the Internal Market -- 7. Canada: The Logic of the Single-Payer System -- The Founding Bargain: Fee-for-Service and the Negotiation of Price -- Provincial-Level Accommodations in the 1970s and 1980s Expenditure Caps in the 1990s -- The Expanding Agenda -- Information and Information Technology -- Changing Profession-Government Relations and the Impact on Organized Medicine -- The Logic of the Profession-State Accommodation -- Institutional and Structural Change in a Single-Payer System -- 8. Conclusion -- The Health Policy Arena in Britain, the United States, and Canada -- Concluding Observations -- Notes -- References -- Index -- A -- B -- C -- D -- E -- F -- G -- H -- I -- J -- K -- L -- M -- N -- O -- P -- Q -- R -- S -- T -- U -- V -- W. Health care reform has become one of the most prevalent topics in recent policy discourse within and across nations. In the 1990s, common features of the health care arena elevated the importance of bargaining relationships among large, sophisticated entities as the dominant mode of decision-making, fundamentally challenging the traditional dominance of the medical profession, which had been grounded in individualized "agency" relationships between providers and patients. These developments have played out in varying ways around the globe. Carolyn Hughes Tuohy looks at the experiences of the United States, Britain, and Canada, offering an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. L What drives change in health care systems? Why do certain changes occur in some nations and not in others? Tuohy argues that the answer lies in understanding the "accidents" of history that have shaped national systems at critical moments and in the distinctive "logics" of these systems.; Her study carefully delineates both the common logic of the health care arena, deriving from micro-economic characteristics and technological change, and the particular logics of national systems, put in place by specific episodes of policy change. She goes on to explore how in the wake of these episodes, the mixed market in the United States, hierarchical corporatism in Britain, and the single-payer system in Canada determined the subsequent direction and pace of change in all three countries. Finally, Tuohy provides suggestions to guide the strategic judgments that decision-makers must make within the health care system of each country. Accidental Logics uniquely departs from the descriptive literature currently available by presenting an extensive review of the evidence regarding the evolution of the health care arenas in the United States, Britain, and Canada, integrated within an explanatory framework. It is essential up-to-date reading for political scientists working in comparative politics and public policy, health policy analysts, government agency officials, and students in political science, health policy, and administration programs Medical care- Canadá- Finance- Decision making Medical care- Great Britain- Finance- Decision making Medical care- United States- Finance- Decision making Medical policy- Canadá- Decision making Medical policy- Great Britain- Decision making Medical policy- United States- Decision making Medical care- Finance- Decision making Medical policy- Decision making Canadá Gran Bretaña Estados Unidos Electronic books Tuohy, Carolyn Hughes Print version Accidental Logics. Oxford University Press, USA 1999 (DLC) 98028698

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monografia Rebiun22455619 https://catalogo.rebiun.org/rebiun/record/Rebiun22455619 m o d cr un|---uuuuu 121028s1999 xx ob 001 0 eng d 778206623 814459175 821693561 1280530421 9781280530425 0195128214 alk. paper) IDEBK eng pn IDEBK OCLCQ EBLCP OCLCQ MERUC ZCU U3W OCLCO OCLCF ICG AU@ OCLCQ DKC OCLCQ n-cn--- e-uk--- n-us--- MBNH bicssc Accidental Logics the Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada Oxford University Press, USA 1999 Oxford University Press, USA 1 online resource 1 online resource Text txt rdacontent computer c rdamedia online resource cr rdacarrier Includes bibliographical references (pages 283-304) and index 1. Understanding the Dynamics of Change in the Health Care Arena -- The Conceptual Framework: The Accidental Logics of Change in Policy Arenas -- Dimensions of Decision-Making Systems: Institutional Mix and Structural Balance -- Policy Episodes and System Logics -- The Economics of Health Care Delivery: Agency, Risk, and Localism -- The Health Policy Agenda of the 1990s -- Britain, the United States, and Canada -- PART I. EPISODES OF POLICY CHANGE -- 2. The Establishment of the Welfare State in the Health Care Arena The Immediate Postwar Period: Britain versus Canada and the United States -- The 1950s and 1960s: The Establishment of Governmental Health Insurance in Canada and the United States -- 3. The Reforms of the 1990s -- Britain -- The United States -- Canada -- 4. Institutions, Ideas, Interests, Actors, and the Accidents of Policy Episodes -- Political Institutions -- Policy Legacies and Path Dependency -- Public Opinion and Cultural Understandings -- Political Culture and Parties -- Interests -- Strategic Judgment -- Understanding Policy Episodes -- PART II. THE DISTINCTIVE LOGICS OF NATIONAL SYSTEMS 5. The United States: The Logic of the Mixed Market -- Regulation in the 1970s -- Prospective Payment in the 1980s -- The Rise of ""Managed Care"" -- Regional versus National Markets -- The Growing Role of For-Profits -- Performance Monitoring and the Role of Clinical Judgment -- Information and Information Technology -- The Changing Political Terrain -- Institutional and Structural Change in the Mixed Market -- The Logic of Entrepreneurialism -- 6. Britain: The Logic of Corporatism Meets the Internal Market -- Corporatism in the NHS -- Managerialism and the Griffiths Reforms The Purchaser-Provider Split: Bargaining in the Internal Market -- Bargaining Roles: The Provider Side -- Bargaining Roles: The Purchaser Side -- Clinical Audit and the Role of Clinical Judgment -- Information and Information Technology -- The Role of the Private Sector -- The Role of Partisan and Electoral Politics -- Institutional and Structural Change in the Internal Market -- The Logic of the Internal Market -- 7. Canada: The Logic of the Single-Payer System -- The Founding Bargain: Fee-for-Service and the Negotiation of Price -- Provincial-Level Accommodations in the 1970s and 1980s Expenditure Caps in the 1990s -- The Expanding Agenda -- Information and Information Technology -- Changing Profession-Government Relations and the Impact on Organized Medicine -- The Logic of the Profession-State Accommodation -- Institutional and Structural Change in a Single-Payer System -- 8. Conclusion -- The Health Policy Arena in Britain, the United States, and Canada -- Concluding Observations -- Notes -- References -- Index -- A -- B -- C -- D -- E -- F -- G -- H -- I -- J -- K -- L -- M -- N -- O -- P -- Q -- R -- S -- T -- U -- V -- W. Health care reform has become one of the most prevalent topics in recent policy discourse within and across nations. In the 1990s, common features of the health care arena elevated the importance of bargaining relationships among large, sophisticated entities as the dominant mode of decision-making, fundamentally challenging the traditional dominance of the medical profession, which had been grounded in individualized "agency" relationships between providers and patients. These developments have played out in varying ways around the globe. Carolyn Hughes Tuohy looks at the experiences of the United States, Britain, and Canada, offering an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. L What drives change in health care systems? Why do certain changes occur in some nations and not in others? Tuohy argues that the answer lies in understanding the "accidents" of history that have shaped national systems at critical moments and in the distinctive "logics" of these systems.; Her study carefully delineates both the common logic of the health care arena, deriving from micro-economic characteristics and technological change, and the particular logics of national systems, put in place by specific episodes of policy change. She goes on to explore how in the wake of these episodes, the mixed market in the United States, hierarchical corporatism in Britain, and the single-payer system in Canada determined the subsequent direction and pace of change in all three countries. Finally, Tuohy provides suggestions to guide the strategic judgments that decision-makers must make within the health care system of each country. Accidental Logics uniquely departs from the descriptive literature currently available by presenting an extensive review of the evidence regarding the evolution of the health care arenas in the United States, Britain, and Canada, integrated within an explanatory framework. It is essential up-to-date reading for political scientists working in comparative politics and public policy, health policy analysts, government agency officials, and students in political science, health policy, and administration programs Medical care- Canadá- Finance- Decision making Medical care- Great Britain- Finance- Decision making Medical care- United States- Finance- Decision making Medical policy- Canadá- Decision making Medical policy- Great Britain- Decision making Medical policy- United States- Decision making Medical care- Finance- Decision making Medical policy- Decision making Canadá Gran Bretaña Estados Unidos Electronic books Tuohy, Carolyn Hughes Print version Accidental Logics. Oxford University Press, USA 1999 (DLC) 98028698