Dynamics Of A Changing Health Sphere: The United States, Britain, And Canada

Abstract

This three-nation comparison dissects the underlying factors motivating and inhibiting health system changes in the turbulent 1990s.by Carolyn Hughes Tuohy PROLOGUE: Canada, the United Kingdom, and the United States represent three largely English-speaking countries that, in their varying forms, are models of contemporary democracy. But the ways in which their health care systems have evolved are quite different as a result of choices made at critical historical points.In this illuminating comparative study, Carolyn Tuohy, a political scientist and deputy provost of the University of Toronto, discusses the substantial differences that separate the nature of the three health care systems and the resulting logic that shaped them. She emphasizes that an important characteristic of these systems is the different ways in which they have structured the relationship between the medical profession and the state.Tuohy earned her doctorate in political science from Yale University. Her research pursuits have focused on comparative public policy, with an emphasis on social policy. This paper distills an argument presented in her most recent book, which was just published by Oxford University Press: Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada. Tuohy also has authored numerous journal articles and book chapters dealing with health and social policy, professional regulation, and comparative approaches in public policy.

Struggles for Meaning and Struggles for Control: The Diffusion of Bandwagon Technology in Two Institutional Environments

“…Taking the private sector as an archetype of success, market mechanisms based on the 'managed care' concept were introduced in the US, thereby creating a third institutional logic which Scott et al (2002) relates to efficiency. While the health care industries in different countries have mixed these logics very differently (Tuohy, 1999), the logics of quality, equity and efficiency are inherent in all of them and very much in evidence in the contexts studied (Denis, Lamothe, Langley, & Guerard, 2003) as we shall see.…”

A consumer-based tool for evaluating the quality of health services in the Israeli health care system following reform

“…In Israel, it has been especially important to monitor the quality of services, as reform has limited the health plans' flexibility in raising funds, increased government control of their financial operation, and limited competition among them. Moreover, the Israeli reform changed the system of incentives, as has been the case in other countries [22,35,36]. The underlying assumption is that people and organizations that provide health care (e.g., hospitals, health plans, physicians) will respond to new incentives in a way that is compatible with the intentions of those who planned the reform.…”

The English National Health Service: 1979-2005

“…The second explanation for the internal market's apparent lack of success was referred to in the introduction; even if the information systems necessary for effective competition were in place (they were not), the organisational institutions of the NHS are not designed to facilitate competition [6,84]. For example, many GPs and, formerly, district health authority managers, have longstanding relationships with the specialists working in their local hospitals, and will be unwilling to undermine the financial position of the Trusts in which these specialists work.…”

“…between general practitioners and specialists), or hierarchical (e.g. between the Department of Health and the purchasers and providers of health care) [6]; incentive mechanisms that are based purely on economic notions of competition are unlikely to succeed in this environment.…”