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

What drives change in health care systems? Why do certain changes occur in some nations and not in others? Author Carolyn Hughes 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. Tuohy looks at the experiences of Britain, Canada, and the US, offering an international comparative study of public policy systems, as well as a recent history of the circumstances in each country that have impacted on the structures of each's national health care system. The guiding focus of the book is Tuohy's study of decision making systems in each country, looking at the decisions made by those who provide, finance, and use health care services. Finally, Tuohy reviews current issues in the health care arenas of these three nations and provides suggestions to guide the strategic judgments that decision-makers must make. 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. 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. Accidental Logics 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.--book Jacket. Ch. 1. Understanding The Dynamics Of Change In The Health Care Arena -- Pt. I. Episodes Of Policy Change -- Ch. 2. The Establishment Of The Welfare State In The Health Care Arena -- Ch. 3. The Reforms Of The 1990s -- Ch. 4. Institutions, Ideas, Interests, Actors, And The Accidents Of Policy Episodes -- Pt. Ii. The Distinctive Logics Of National Systems -- Ch. 5. The United States: The Logic Of The Mixed Market -- Ch. 6. Britain: The Logic Of Corporatism Meets The Internal Market -- Ch. 7. Canada: The Logic Of The Single-payer System -- Ch. 8. Conclusion. Carolyn Hughes Tuohy. Includes Bibliographical References And Index. Looks at the USA, Britain and Canada to offer an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. The book explores what drives change and why certain changes occur in some nations and not in others Tuohy looks at the experiences of Britain, Canada, and the US, offering an international comparative study of public policy systems, as welt as a recent history of the circumstances in each country that have impacted on the structures of each's national health care system. In the last two decades of the twentieth century, health care was not far from the top of the policy agenda in any advanced industrial nation.