Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada
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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 choice-making, fundamentally challenging the habitual dominance of the medical profession, which had been grounded in individualized “agency” relationships between providers and patients. These developments have played out in unreliable ways nearly the globe. Carolyn Hughes Tuohy looks at the experiences of the United States, Britain, and Canada, offering an international comparative study of broadcast policy systems, as well as a recent history of the evolution of each national health care system.
What drives exchange in health care systems? Why do certain changes occur in some nations and not in others? Tuohy argues that the resolution 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 judgment of the health care arena, deriving from micro-economic characteristics and technological exchange, and the particular logics of national systems, place in place by specific episodes of policy exchange. 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 later direction and pace of exchange in all three countries. Finally, Tuohy provides suggestions to guide the strategic judgments that choice-makers must make within the health care system of each people. Accidental Logics uniquely departs from the descriptive literature now 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 broadcast policy, health policy analysts, government agency officials, and students in political science, health policy, and administration programs.
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