Suchergebnisse

Introduction: cost containment and the governance of heath care -- Health care governance in the British NHS to 1989: a hybrid of corporatism and state hierarchy -- The British reforms: markets, managers, and the challenge to corporatism -- The corporatist settlement in German national health insurance -- The German reforms: grafting the market onto corporatism -- The autonomy of the solo practitioner in a liberal health care system: the United States -- Market reform as "unmanaged competition": the United States -- Conclusion: the limits of markets in health care

Includes bibliographical references (p.263-291) and index. ; Introduction: cost containment and the governance of heath care -- Health care governance in the British NHS to 1989: a hybrid of corporatism and state hierarchy -- The British reforms: markets, managers, and the challenge to corporatism -- The corporatist settlement in German national health insurance -- The German reforms: grafting the market onto corporatism -- The autonomy of the solo practitioner in a liberal health care system: the United States -- Market reform as "unmanaged competition": the United States -- Conclusion: the limits of markets in health care. ; Mode of access: Internet.

Health care systems in the postwar period have been governed by political bargains between the state and the medical profession that have delinzated their respective powers and jurisdictions. Recent health care cost containment reforms in Britain and Germany are altering these bargains, and thereby challenge the prerogatives and autonomy of the medical profession in health policy formulation and in administration of the health care systems. But these challenges to doctors' power and autonomy vary between the two countries. Britain's 1989 "internal market" reforms attack the corporatist bargain with physicians by introducing market mechanisms into the National Health Service and, at the same time, strengthening central state control of the health care system. In Germany, on the other hand, the government's 1992 reforms only partially breached the corporatist bargain with doctors in order to strengthen rather than destroy this governance arrangement. The government has tried to curb what it views as excessive power of doctors while still allowing them a significant degree of corporatist self‐governance. The reform efforts in both countries highlight some of the problems with different governance arrangements in health care systems and, more specifically, the difficulties associated with a market in health care.

Welfare states in all advanced industrialized countries are under severe financial stress. Many observers argue that in responding to such pressures, governments are converging on a path of marketization and privatization of social risks, which ultimately leads to the unraveling of solidarity. Recent health care reforms in Britain, Germany, and the United States serve as case studies that challenge this argument. Far from converging on a market path, each country has pursued a distinctive reform response combining markets with other policy instruments. Moreover, where state actors lead the way in constructing health care markets, the extent of desolidarity is limited. The structure of each nation's health care system shapes the policy preferences and reform strategies of key actors, and thereby helps explain the distinctiveness of health care reform patterns.