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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 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. 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.

The Health Care Policy Process enables the reader to develop an understanding of the scope and objectives of health policy studies, an analysis of the extent to which policies can be changed or influenced by those involved at the different stages of the policy process and the ability to assess both the need and the scope for change. Taking as her starting point an analysis of the health care system and the dynamics of the policy process, Carol Barker considers the relationship between planning and policy. Providing a working knowledge of the different ways in which policy issues may be analysed, the book sets out the problems involved in attempting to assess the views of different interest groups, and stresses the importance of supporting an active process of policy development. Carol Barker goes on to look at key concepts in analysing health care issues and examines some of the debates overshadowing today′s health policy agenda, in part as set by international agencies and in part as set by developing nations themselves. She emphasizes the importance of understanding the dimensions of these issues in a way which will help those organizing health care to think strategically about the policy implications of health plans and policies. This book will be essential reading for students and academics of health care policy, as well as for those involved in the policy process, whether as policy makers, researchers, managers of health care professionals.

Traditionally in health care and in the public sector more generally, little thought has been given to the impact of provider-oriented incentives on the delivery of services. There has been an assumption that the language of incentives belonged to the private sector and was inappropriate in the public sector. Implicitly there has been an expectation that the ethical stance of clinicians would ensure that their actions were always in the best interest of patients. However, in the context of a heightened awareness of cost constraints there has been a greater emphasis on the active management of resources in medical organizations. Llewellyn et al argue that the structure of incentives in health care is highly significant in resource allocation, as medical ethics does not provide an unambiguous guide to clinical decision making. By undertaking a comparison between the UK and Canada, they identify the differential nature of the incentives present in the health care systems of these two countries and discuss some of their consequences.