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

By Carolyn Hughes Tuohy

What drives swap in health and wellbeing care structures? Why do convinced adjustments happen in a few countries and never in others? writer Carolyn Hughes Tuohy argues that the reply lies in figuring out the "accidents" of background that experience formed nationwide platforms at serious moments, and within the unique "logics" of those platforms. Tuohy seems to be on the reports of england, Canada, and the USA, supplying a world comparative examine of public coverage platforms, in addition to a contemporary historical past of the conditions in each one kingdom that experience impacted at the constructions of each's nationwide well-being care method. The guiding concentration of the e-book is Tuohy's learn of choice making structures in each one kingdom, the selections made through those that offer, finance, and use future health care providers. ultimately, Tuohy studies present matters within the wellbeing and fitness 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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In Sweden, the Netherlands, and New Zealand, government commissions appointed to consider the appropriate scope of a basic package of publicly insured services produced sets of criteria, without defining the actual services to be included or excluded. S. state of Oregon to identify a list of procedures, in order of priority, to be covered under a program to provide health insurance to all individuals and families with incomes below the federally defined poverty level (Garland 1991; Klein et al.

For much of the twentieth century the overall pattern of the production of health care services was little more than the aggregate of decisions made by autonomous physicians in their local hospitals and practices, although both small-scale private practice and systems of collegial decision-making were threatened by the rise of large private hierarchical organizations in the 1970s and 1980s (Starr 1982; Salmon 1994). In addition, the heavy reliance on market mechanisms meant that attempts to control medical behavior increasingly took the form of explicit contractual arrangements.

States expanded access to health insurance for their low-income popula' tions (Holahan et al. 1995b), and both federal and state legislation attempted to expand access through reform of private insurance markets, as will be discussed later in this book. In general, however, the proportion of the population without health insurance continued to grow in the absence of a universal plan (Thorpe 1997: 354-58). Understanding the Dynamics of Change in the Health Care Arena 21 Cost control The period since the mid-1970s saw a progressive tightening of budget caps at the sectoral, institutional, and individual levels, and in some cases an increased reliance on cost-shifting.

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