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IMPLEMENTING CHANGE IN HEALTH SYSTEMS: MARKET REFORMS IN HEALTH SYSTEMS IN THE UNITED KINGDOM, SWEDEN AND THE NETHERLANDS


Michael I. Harrison
Sage, 2004, 256 pp., £21.99 (pb) ISBN: 0761961763

Examines policy changes in the 1980s in the British National Health Service, highlighting the impact of these changes on general practitioners. These policy changes stressed the introduction of market principles into medical care accomplished through a shift toward primary care, an alteration of funding & allocation procedures, & an enhancement of patient rights. It is argued that these changes have increased opportunities for general practitioners to manage the scope of their work & control resources used to provide medical care. While remaining beyond day-to-day scrutiny, general practitioners have gained more freedom to make medical decisions & bargain with other service providers. Thus, the main consequence of the introduction of market principles has been to retract state supervision & allow market criteria to determine medical provision outcomes. 37 References. D. M. Smith

The paper examines 110 complaints about general practitioners adjudicated by a health authority. This was a 10 percent subset of complaints received. Complainants' letters were analyzed in order to identify the issues complained about, who complained, what they wanted and how they structured their accounts. The most common single cause of complaint was the lack of a home visit but a third involved issues of diagnosis and treatment. Most people complained to get an investigation rather than for personal redress. Very few considered suing. Doctors, in their response to complaints adopted a number of defence strategies. In a minority of cases they stepped outside the bounds of professional behavior. In the light of impending changes in complaints systems in the U.K., it is argued that a forum for the expression of conflicting accounts remains.

In recent years the health services in Great Britain have been subjected to unprecedented regulatory changes. After a review of the overall issues, including the impact of globalization, the text explores recent changes in regard to different healthcare professions

This paper considers concepts of citizenship and consumerism in light of complaints about healthcare, which have risen since the early1990s, due to a greater willingness by the healthcare user to complain, and also the reforms in complaint systems. The narrow legal model for dealing with complaints has been replaced by a managerial model based on corporate sector practice that views complaint handling as a way of retaining customers and organisational learning. The managerial model has proved difficult to embed into the English NHS and has been superposed with a centralised regulatory system that aims to manage performance while also being responsible for reviewing, complaints and being responsive to complainants. It is argued that this may have positive consequences in terms of improving healthcare quality but more negatively, the promotion of consumerism within complaints processes has led to a loss of the right to due process and public accountability.

This chapter compares transformations in professional self-regulation in the UK and Germany through the lens of governance. We introduce an expanded concept of governance that includes national configurations of state–;profession relationships and places selfregulation in the context of other forms of governance. The analysis shows that a general trend towards network governance plays out differently. In the UK, a plural structure of network governance and stakeholder arrangements is emerging in the context of stateled change. In Germany, partnership governance between sickness funds and medical associations shape the transformations and act as a barrier towards the entry of new players.

This paper examines the neglected area of health support work in the United Kingdom in the context of recent social policy and studies of professionalisation. A variety of socio-economic trends have led policy makers to give greater consideration to this section of the healthcare workforce. Professional regulatory issues and recent reviews in the health field have provided the leverage to alter existing healthcare boundaries, as well as to enhance public protection. Drawing on commissioned research, it is argued that health support workers are not only an important area of study in their own right, but also raise interesting questions about the broader process of health policy making and professionalisation.