Carolyn Hughes Tuohy's Accidental Logics: The Dynamics of Change in the Health Care PDF

By Carolyn Hughes Tuohy

ISBN-10: 0195128214

ISBN-13: 9780195128215

What drives swap in healthiness care platforms? Why do yes adjustments ensue in a few international locations and never in others? writer Carolyn Hughes Tuohy argues that the reply lies in realizing the "accidents" of historical past that experience formed nationwide structures at severe moments, and within the precise "logics" of those platforms. Tuohy seems to be on the studies of england, Canada, and the united states, providing a world comparative learn 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 overall healthiness care process. The guiding concentration of the booklet is Tuohy's examine of choice making structures in every one kingdom, the selections made by means of those that offer, finance, and use wellbeing and fitness care prone. eventually, Tuohy stories present concerns within the health and wellbeing care arenas of those 3 international locations and offers feedback to steer the strategic judgments that decision-makers needs to make.

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

Sample text

The power of provincial governments was essentially that of the monopsonist. Almost the last vestige of the individual physician's discretion over the price of service disappeared in 1984, with the passage of federal legislation providing for fiscal penalties to any province allowing "extra billing" (billing beyond the amount covered by the government plan) for medical and hospital services. But physicians continued to have broad discretion over the location of their practices, the inputs to their practices, and the volume and mix of services they delivered.

But the basic structure of Canada's "internal market," the balance between public and private finance, and, most significantly, the influence of the medical profession and the importance of collegial mechanisms of decision-making remain essentially unchanged. Whether this relative stability can persist in the face of the unprecedented fiscal constraint of the 1990s, however, is a key question to be addressed. Each of these observations, on its face, opens up a puzzle. First, why was it in Britain that the most radical policy change regarding the institutional mix and structural balance occurred in the 1990s?

Other types of private charges, in the form of unregulated billing above the rates covered by public insurance, actually decreased in a number of nations in the 1980s and early 1990s. In Canada, such charges for medical and hospital services were disallowed under federal legislation establishing the criteria for federal contributions to provincial health insurance plans in 1984. In Australia, the incidence of such charges for medical services outside hospitals decreased steadily after the reintroduction of universal health insurance by the Labour government in 1984, although the issue, as well as that of the role of private insurance, has continued as a prominent issue of political debate (Gray 1996).

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Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada by Carolyn Hughes Tuohy

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