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The health debate

The health debate

David J. Hunter
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  • Book Info
    The health debate
    Book Description:

    Health care systems across the world are in a state of permanent revolution as they struggle to cope with multiple pressures arising from changing demography, new technologies, and limited resources. Focusing on the British NHS, this book offers a fresh look at how it has coped with such pressures over its 60 year history and considers what the future holds. The book explores the complexity of health policy and health services, offering a critical perspective on their development. The health debate offers a lively and accessible reassessment of successive reforms of the NHS and their cyclical nature. The book will appeal to all students of health care and health policy, and to policy-makers and health care professionals.

    eISBN: 978-1-84742-367-2
    Subjects: Health Sciences

Table of Contents

  1. 1 Key challenges facing health systems
    (pp. 1-22)

    The reader may wonder why another book on health policy is deemed necessary given the numerous texts already available, many of them updated versions of earlier ones. It is a fair question. In defence of this text, it attempts to do a different job. The aim of the book is to review some of the key contemporary debates evident in health systems and consider how they have shaped the way in which such systems have evolved over time and continue to evolve. It is not a traditional comparative text since its principal focus is on health policy developments in the...

  2. 2 Meeting the health system challenges
    (pp. 23-50)

    In Chapter One, mention was made of the value of a comparative approach in describing and understanding health systems while bearing in mind the limitations of such an approach and the tendency to overlook key cultural and historical differences between countries and their health systems. These cultural and historical factors often play a major role in the way those systems function regardless of the details of their funding and organisation. Through making comparisons it is possible to identify both commonalities and differences. The notion of convergence in an increasingly globalised world was also considered in the previous chapter. Whatever the...

  3. 3 Models of health system reform
    (pp. 51-88)

    This chapter describes and analyses the three phases, and contrasting models, of reform of the UK NHS that have occupied the government, principally key ministers and their advisers, since 1997. They have been articulated by one of the government’s most influential health policy advisers, Simon Stevens, who labelled the phases as follows:

    benign producerism

    command and control

    new localism.

    Stevens subsequently left his position as adviser to the former prime minister, Tony Blair, to take up a new post as president of United Health in Europe. United Health is a major US health care provider, which happens to be competing...

  4. 4 Choice and competition in health systems
    (pp. 89-118)

    In recent years, choice and competition have become central planks of health policy in many countries. Such notions are in keeping with the consumerist ethos that is now prevalent in health system reform thinking, and the growing marketisation or commodification of health care noted in earlier chapters. Of course, it is quite possible to have choice without competition, and competition without allowing choice. However, the two are generally regarded as going hand in hand since choice without competition may result in people not having a sufficient range of options from which to choose – the problem of choosing any colour as...

  5. 5 Priority setting in health systems
    (pp. 119-140)

    Another recurring policy dilemma concerns the rationing of health care, or, as some prefer to call it, priority setting. The discourse here is about the extent to which rationing health care should (or can) be explicit or whether the implications are too painful to contemplate, which makes implicit rationing a more attractive option. This chapter reviews the arguments on both sides.

    Not so long ago, in the 1980s and 1990s, the term ‘rationing’ was on the lips of every health policy maker in countries around the world, including the US, New Zealand and the UK. The word was often invoked...

  6. 6 Moving upstream: the dilemma of securing health in health policy
    (pp. 141-178)

    One of the curious ironies of most health systems is that few pay much attention to health, focusing instead on ill-health and disease. They are, in the words of the secretary of state for health in England, Alan Johnson, diagnose-and-treat systems rather than systems designed to predict and prevent. They operate in such a fashion even when making a pretence of putting health before health care. A good example of this tendency is a speech delivered by a former British health secretary, Alan Milburn. The lecture was given in 2002, two years after he launched his 10-year NHS Plan that,...

  7. 7 The health debate: what and where next?
    (pp. 179-200)

    Health system reform is likely to remain an international preoccupation as countries of different political persuasions and at different stages of development seek to balance rising demand and limited resources. In balancing this, policy makers have to wrestle with a variety of interlocking political cleavages that constitute an ongoing health debate.

    The purpose of this book has been to describe and analyse the principal policy cleavages that have exercised, and continue to preoccupy, policy makers in their pursuit of the perfect health system. On the evidence reviewed here, such a laudable goal is probably unattainable – less imperfection is the best...

  8. Index
    (pp. 219-228)