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Comparative Studies and the Politics of Modern Medical Care

Comparative Studies and the Politics of Modern Medical Care

Copyright Date: 2009
Published by: Yale University Press
Pages: 352
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  • Book Info
    Comparative Studies and the Politics of Modern Medical Care
    Book Description:

    This book offers a timely account of health reform struggles in developed democracies. The editors, leading experts in the field, have brought together a group of distinguished scholars to explore the ambitions and realities of health care regulation, financing, and delivery across countries. These wide-ranging essays cover policy debates and reforms in Canada, Germany, Holland, the United Kingdom, and the United States, as well as separate treatments of some of the most prominent issues confronting policy makers. These include primary care, hospital care, long-term care, pharmaceutical policy, and private health insurance. The authors are attentive throughout to the ways in which cross-national, comparative research may inform national policy debates not only under the Obama administration but across the world.

    eISBN: 978-0-300-15595-2
    Subjects: Political Science, Public Health

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-xii)
    Ted Marmor, Kieke Okma and Richard Freeman
  4. Acknowledgments
    (pp. xiii-xiv)
  5. 1 Comparative Policy Analysis and Health Care: An Introduction
    (pp. 1-23)

    None of us can escape the “bombardment of information about what is happening in other countries” (Klein 1997). Yet in the field of health policy, which is our subject, there is a considerable imbalance between the magnitude and speed of the information flows and the capacity to learn useful lessons from them.¹ There is, moreover, a substantial gap between promise and performance in the field of comparative policy studies. Misdescription and superficiality are all too common. Unwarranted inferences, rhetorical distortion, and caricatures all show up too regularly in comparative health policy scholarship and debates. Why might that be so, and...

  6. 2 The United States: Risks for Americans and Lessons for Abroad
    (pp. 24-60)

    Comparative health policy commentators who discuss the United States have had the unenviable job of reporting on a system that is much less equal and much less adequate than the health care system in any of the other four countries discussed in this volume—even though it is also much more expensive.¹

    However, we do have some comparative advantages that may make our participation worthwhile for the others. One is that American experience can serve as a cautionary tale. It is easy to look at any human organization and see problems. It is sometimes harder to see successes because what...

  7. 3 Canada: Health Care Reform in Comparative Perspective
    (pp. 61-87)

    It is a sobering task to revise this chapter on the Canadian health system written in 1996, especially given the history of the period from 1996 to 2008. This chapter was originally presented as a paper at a time that, history now shows to have marked the depths of an unprecedented trough in public spending on health care in Canada—the effects of which were then only beginning to be felt. Between 1992 and 1996, real per-capita public health care spending declined by about 8 percent. These fiscal changes were part of broad governmental agendas, at both federal and provincial...

  8. 4 Germany: Evidence, Policy, and Politics in Health Care Reform
    (pp. 88-119)

    The complex and wide-ranging field of health policy making can be traversed along different routes and with different perspectives in mind. The route chosen depends, among other things, on an understanding of the very pattern of organization and operation, representing, as it were, the “lay of the land.” Accordingly, this chapter starts with a brief description of the German health care system and its operation—its political dynamics and its recent evolution. Next, the chapter turns to the role of evidence and learning in general and in the German context in particular, citing examples of evidence versus interests and power...

  9. 5 The Netherlands: From Polder Model to Modern Management
    (pp. 120-152)

    This chapter focuses on how managers in Dutch health insurance and health care have addressed the challenges of a rapidly changing business environment. It starts with a brief description of health care in the Netherlands at the beginning of the twenty-first century. That system shares some features with other European countries, but it also has particular characteristics. For example, the long tradition of health care funded and provided by nongovernment actors has shaped the administrative arrangements still visible today.¹ The typical Dutch neocorporatist policy-making style, with extensive consultations with organized interest groups, often bears the label of the Dutch Polder...

  10. 6 The United Kingdom: Health Policy Learning in the National Health Service
    (pp. 153-179)

    Health systems can be seen as the way a country assumes and then exerts collective responsibility for protection against the risks of injury and illness. Those risks include the maintenance of health as well as the medical and financial consequences of falling ill. Everywhere such arrangements rest on political settlements of different kinds: between the state and economic actors, principally employers and employees, about how to finance the system and whom it should serve; and between the state and doctors about the conditions under which to provide and pay for health care. In combination, these effectively define the extent of...

  11. 7 Primary Care and Health Reform: Concepts, Confusions, and Clarifications
    (pp. 180-202)

    The national health care arrangements emphasized in this book—of Germany, the Netherlands, Canada, the United States, and the United Kingdom—undeniably differ in the structure of their governing institutions, the ways they finance and contract medical care, and in subtle cultural forms. The earlier chapters demonstrate these differences. Yet, it is also the case that in the period since the stagflation of the 1970s, the repertoire of proposed “health reforms” seemed quite similar across these and other wealthy democracies. At the level of discourse, one of the most sacred cows of Western health policy, the topic of primary care—...

  12. 8 Hospital Care in the United States, Canada, Germany, the United Kingdom, and the Netherlands
    (pp. 203-243)

    Hospitals in Western Europe have their historical roots in medieval institutions that provided shelter, food, and care for the sick, the homeless, the elderly, and the mentally deranged (De Swaan 1988). The institutions were funded and managed by monasteries, local communities, and charities. Over time, the roles and functions of hospitals gradually extended to include medical treatment, nursing and spiritual care, isolation of contagious disease, and education and research (Healy and McKee 2002). In the second half of the nineteenth century, the state showed growing interest in matters of public health and health care. The Poor Laws in the United...

  13. 9 Pharmaceutical Policy and Politics in OECD Countries
    (pp. 244-264)

    Perhaps the key difference in the practice of medicine at the beginning of the twenty-first century compared to a hundred or even fifty years ago is the prescription and use of therapeutic drugs. With this change, health politics has changed, too.

    For health care is a problem of political economy. When health care states were established, the problem became the distribution of its costs, between capital and labour, employers and employees, tax payers and patients. And in most countries and systems, the question of who bears the health financing is still contentious. As far as pharmaceuticals are concerned, however, what...

  14. 10 Comprehensive Long-Term Care in Japan and Germany: Policy Learning and Cross-National Comparison
    (pp. 265-287)

    In an era when retrenchment and constraints seem to dominate welfare-state agendas, long-term care (LTC) stands out as an area of expansion in several countries. As in other areas of social policy, Scandinavia was the first to see the problems of frail elderly people and those who care for them as a proper object of national concern. Sweden (in the 1970s) and Denmark (in the 1980s) substantially expanded LTC. Municipal governments delivered the care, paid from taxes (Sundström and Thorslund 1994). In the 1990s, both Germany and Japan took another tack by creating public, mandatory long-term care insurance (LTCI) programs...

  15. 11 Regulating Private Health Insurance Markets
    (pp. 288-304)

    Compared to other sources of health care finance, private health insurance (PHI) is of minor importance in Western Europe and Canada. On average, private health insurance contributes less than 10 percent to health expenditures in these countries. However, PHI played a relatively significant role in the Netherlands (15 percent), Canada (11 percent) and Germany (13 percent) in 2000 (Colombo and Tapay 2004).¹ Within the OECD, it is only in the United States that PHI accounts for more than 30 percent of health care expenditure (roughly one-third of all health care expenditures). Some critics argue that the high level of American...

  16. 12 Learning from Others and Learning from Mistakes: Reflections on Health Policy Making
    (pp. 305-318)

    Learning about other countries is rather like breathing: Only the brain-dead are likely to avoid the experience. None of us can escape the bombardment of information about what is happening in other countries. The process of learning takes many forms. There is the kind of face-to-face exchange of experience that characterizes conferences and similar meetings. There is the systematic diffusion of information by the Organisation for Economic Cooperation and Development (OECD) and other international organizations. There is the annual pilgrimage of academics from conference to conference. There are the formal contacts between politicians and civil servants within the framework of...

  17. Appendix: National Health Accounts: A Tool for International Comparison of Health Spending
    (pp. 319-346)
  18. Contributors
    (pp. 347-348)
  19. Index
    (pp. 349-354)