Advertisement

Conclusion: Grains Among the Chaff — Rhetoric and Reality in Comparative Health Policy

  • James W. Björkman

Abstract

The industrialised democracies of the world confront a complex dilemma. A seemingly insatiable demand for health care is outstripping supply, despite a relentless increase in the latter’s share of national budgets and family incomes. Yet there is little corresponding rise in general health indices, or even in human happiness about the quality of medical services. The inability of health services to deliver greater health for more money has ironically not blunted the public’s appetite for them; rather it has perversely increased it. Among the evident reasons for this paradox are that affluent humanity is less prepared than ever before to suffer minor ailments without drugs or other medical help; that demand for health care has been further stimulated both by new treatments for curable diseases and by expanded coverage throughout the poorer levels of society; that new cures for old diseases come with ever higher price tags for their sophisticated technology, so that much additional spending still saves few lives; and that the elderly, whose relative numbers in society are growing, require more routine medical care than the young. Clearly health services in the developed North are victims of their own successes.

Keywords

Health Service Health Sector Medical Professional Discriminant Function Analysis American Political Science Association 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliography

  1. Alford, R.R. (1975) Health Care Politics: Ideological and Interest Group Barriers to Reform (University of Chicago Press).Google Scholar
  2. Altenstetter, C. (1974) Health Policy Making and Administration in West Germany and the United States (Beverly Hills, California: Sage Publications).Google Scholar
  3. Altenstetter, C. (1980) ‘Hospital Planning in France and the Federal Republic of Germany’, Journal of Health Politics, Policy and Law, no. 5, pp. 309–32.Google Scholar
  4. Altenstetter, C. and J.W. Björkman, (1983) Federal-State Health Policies and Impacts: The Politics of Implementation (Washington, DC: University Press of America, 1978).Google Scholar
  5. Altenstetter, C. and J.W. Björkman, ‘Planning and Implementation: A Comparative Perspective on Health Policy’, International Political Science Review, no. 13, pp. 73–91.Google Scholar
  6. Aluwihare, A.P.R. (1982) ‘Traditional and Western Medicine Working in Tandem’. World Health Forum. vol. 3. no. 4. pp. 450–1.Google Scholar
  7. Ameline, C.E. (1984) ‘Philosophy and Cost of Health Care in France’, in Virgo, loc. cit., pp. 17–29.Google Scholar
  8. Anderson, O.W. (1972) Health Care: Can There Be Equity? The United States, Sweden, and England (New York: John Wiley and Sons).Google Scholar
  9. Anderson, O.W. and J.W. Björkman, (1980) ‘Equity and Health Services: Sweden, Britain, and the United States’, in Heidenheimer and Elvander, loc. cit., pp. 223–37.Google Scholar
  10. Ashford, D. (ed.) (1980) Comparative Public Policies: New Concepts and Methods (Beverly Hills, California: Sage Publications).Google Scholar
  11. Banerji, D. (1972) ‘Social and Cultural Foundations of Health Services Systems’, Economic and Political Weekly (Special August Number) pp. 1333–45.Google Scholar
  12. Barnard, K. and K. Lee (eds) (1977) Conflicts in the National Health Service (London: Croom Helm).Google Scholar
  13. Bausell, R.B. and A.J. Rinkus, (1979) ‘A Comparison of Written Versus Oral Interviews’. Evaluation and the Health Professions, vol. 2, no. 4, pp. 477–86.CrossRefGoogle Scholar
  14. Berki, S.S. (1985) ‘DRGs, Incentives, Hospitals, and Physicians’, Health Affairs, vol. 4. no. 4. pp. 70–76.CrossRefGoogle Scholar
  15. Berlant, J.L. (1975) Profession and Monopoly: A Study of Medicine in the United States and Great Britain (Berkeley: University of California Press).Google Scholar
  16. Björkman, J.W. (1977) ‘Political-Administrative Relationships in Development: Contributions and Constraints’, in Sharma, loc. cit., pp. 601–616.Google Scholar
  17. Björkman, J.W. (1979) The Politics of Administrative Alienation (Delhi: Aianta Publications).Google Scholar
  18. Björkman, J.W. (1982) ‘Professionalism in the Welfare State: Sociological Saviour or Political Pariah?’ European Journal of Political Research, no. 10, pp. 407–28.Google Scholar
  19. Björkman, J.W. (1984) ‘Health Policy and Politics in Sri Lanka: Developments in the South Asian Welfare State’. Asian Survey, vol. 34, no. 5, pp. 211–40.Google Scholar
  20. Björkman, J.W. (1985) ‘Who Governs the Health Sector? Comparative European and American Experiences with Representation, Participation and Decentralisation’, Comparative Politics, no. 17, pp. 399–420.Google Scholar
  21. Björkman, J.W. (ed.) (1986) The Changing Division of Labour in South Asia: Women and Men in Politics, Economics, Society (Riverdale, Maryland: The Riverdale Company).Google Scholar
  22. Björkman, J.W. (1987) ‘Health Policies and Human Capital: The Case of Pakistan’, Pakistan Development Review, no. 11, pp. 411–30.Google Scholar
  23. Björkman, J.W. (ed.), (1988) Fundamentalism, Revivalists, and Violence in South Asia (New Delhi: Manohar Publishers).Google Scholar
  24. Björkman, J.W. (1989) ‘Politicising Medicine and Medicalising Politics: Physician Power in the United States’, in Freddi and Björkman, loc. cit., pp. 28–73.Google Scholar
  25. Björkman, J.W. and C. Altenstetter, (1979) ‘Accountability in Health Care: An Essay on Mechanisms, Muddles, and Mires’, Journal of Health Politics, Policy, and Law, no. 4, pp. 360–81.Google Scholar
  26. Björkman, J.W. and B.W. Coyer, (1980) ‘Comparative Policy Research and Discriminant Function Analysis’, Political Change (Jaipur, India) no. 3, pp. 26–46.Google Scholar
  27. Björkman, J.W. and G.A. Silver (1978) ‘Citizen Control of Health Services: An International Perspective on Participation, Representation, and Social Policy’, Proceedings of the Ninth World Congress of Sociology (Uppsala, Sweden, 12–19 August).Google Scholar
  28. Bornstein, S. et al. (eds), (1984) The State in Capitalist Europe (London: Allen and Unwin).Google Scholar
  29. Brown, L.D. (1982) The Political Structure of the Federal Health Planning Program (Washington, DC: The Brookings Institution)Google Scholar
  30. Carder, M. and B. Klingeberg, (1980) ‘Towards a Salaried Medical Profession? How “Swedish” Was the Seven Crowns Reform?’, in Heidenheimer and Elvander. loc. cit.. pp. 143–72.Google Scholar
  31. Charles, C.A. (1976) ‘The Medical Profession and Health Insurance: An Ontario Case Study’, Social Science and Medicine no. 10. pp. 33–8.Google Scholar
  32. Cleverly, W. (ed), (1982) Handbook of Health Care Accounting and Finance (Maryland: Aspen Publishing).Google Scholar
  33. Cochrane, A.C. (1972) Effective Uses and Efficiency: Random Reflections on Health Services (London: The Nuffield Provincial Hospitals Trust).Google Scholar
  34. Cohen, S.S. and C. Goldfinger, (1975) ‘From Permacrisis to Real Crisis in French Social Security: The Limits to Normal Politics’, in Lindberg et al., loc. cit., pp. 57–98Google Scholar
  35. Commonwealth Secretariat, (1982) The Contribution of Medical Schools to National Health Development (Report of a Commonwealth Workshop at Kandy, Sri Lanka) (London: Marlborough House).Google Scholar
  36. Derber, C. (ed.), (1982) Professionals as Workers: Mental Labour in Advanced Capitalism (Boston: G.K. Hall).Google Scholar
  37. Derber, C. (1983) ‘Sponsership and Control of Physicians’, Theory and Society, no. 12. pp. 561–601.Google Scholar
  38. Döhler, M. (1989) ‘Physicians’ Professional Autonomy in the Welfare State: Endangered or Preserved?’, in Freddi and Björkman, loc. cit., pp. 178— 97.Google Scholar
  39. Dudley, A. (1984) ‘The DRG Tug-of-War’, Medicine and Computers (September–October) pp. 34–7.Google Scholar
  40. Ehrenreich, J. (ed.), (1978) The Cultural Crisis of Modern Medicine, (New York: Evergreen Press).Google Scholar
  41. Elling, R.H. (1980) Cross-National Study of Health Services: Political Economies and Health Care, (New Brunswick, New Jersey: Transaction Books).Google Scholar
  42. Elston, M.A. (1977) ‘Medical Autonomy: Challenges and Responses’, in Barnard and Lee. op. cit.. pp. 26–51.Google Scholar
  43. Evans, J.R., K. Hall and J. Warford, (1981) ‘Health Care in the Developing World: Problems of Scarcity and Choice’, New England Journal of Medicine, no. 305, pp. 1117–27.Google Scholar
  44. Field, M.G. (1980) ‘The Health System and the Polity: A Contemporary American Dialectic’, Social Science and Medicine, no. 14A, pp. 397–413.Google Scholar
  45. Franda, M. (1983) Voluntary Associations and Local Development in India (New Delhi: Young Asia Publications).Google Scholar
  46. Frazier, H.S. and H.H. Hiatt, (1978) ‘Evaluation of Medical Practices’, Science, no. 200, pp. 875–8.Google Scholar
  47. Freddi, G. and J.W. Björkman (eds) (1898) Controlling Medical Professionals: The Comparative Politics of Health Policies (London: Sage Publica-tions).Google Scholar
  48. Freidson, E. (1970) Professional Dominance (Chicago: Aldine Publishing Company).Google Scholar
  49. Freidson, E. (1975) The Profession of Medicine: A Study of the Sociology of Applied Knowledge (New York: Dodd, Mead and Company).Google Scholar
  50. Freidson, E. (1985) ‘Reorganisation of the Medical Profession’, Medical Care Review, no. 42, pp. 11–35.Google Scholar
  51. Fuchs, V.R. (1974) Who Shall Live? Health, Economics, and Social Choice (New York: Basic Books. Inc.).Google Scholar
  52. Fuchs, V.R. (1981) ‘The Coming Challenge to American Physicians’, New England Journal of Medicine, no. 304, pp. 1487–90.Google Scholar
  53. Fuchs, V.R. (1982) ‘The Battle for Control of Health Care’, Health Affairs, vol. 1, no. 2, pp. 5–13.CrossRefGoogle Scholar
  54. Giddens, A. and G. Mackenzie (eds), (1982) Social Class and the Division of Labour (Cambridge: Cambridge University Press).Google Scholar
  55. Glaser, W.A. (1978) Health Insurance Bargaining: Foreign Lessons for Americans (New York: Gardner Press).Google Scholar
  56. Godt, P.J. (1984) ‘Doctors and Deficits:’ Regulating the Medical Profession in France’, Proceedings of the annual meeting of the American Political Science Association (Washington, DC: September).Google Scholar
  57. Golladay, F. and B. Liese, (1980) Health Problems and Policies in the Developing Countries (Washington, DC: The World Bank).Google Scholar
  58. Goodman, J.C. (1980) The Regulation of Medical Care: Is the Price Too High? (San Francisco: Cato Institute).Google Scholar
  59. Grant, J.P. (1976) ‘A Fresh Approach to Meeting Basic Human Needs of the World’s Poorest Billion: Implications of the Chinese and Other “Success” Models’, Proceedings of the annual meeting of the American Political Science Association (Chicago: 2–4 September).Google Scholar
  60. Gray, B. (ed.), (1983) New Health Care for Profit (Washington, DC: National Academy Press).Google Scholar
  61. Harrison, S. and R.I. Schulz, (1989) ‘Clinical Autonomy in Britain and the United States: Contrasts and Convergences’, in Freddi and Björkman, op. cit., pp. 198–209.Google Scholar
  62. Heidenheimer, A.J. (1980) ‘Conflicts and Compromises Between Professional and Bureaucratic Health Interests, 1947–1972’, in Heidenheimer and Elvander, loc. cit., pp. 119–42.Google Scholar
  63. Heidenheimer, A.J. and N. Elvander (eds), (1980) The Shaping of the Swedish Health System (London: Croom Helm).Google Scholar
  64. Heller, T. (1978) Restructuring the Health Service (London: Croom Helm).Google Scholar
  65. Herzlich, C. (1982) ‘The Evolution of Relations Between French Physicians and the State from 1880 to 1980’, Sociology of Health and Illness, no. 4, pp. 241–53.Google Scholar
  66. Hessler, R.M. and A.C. Twaddle, (1982) ‘Sweden’s Crisis in Medical Care: Political and Legal Changes’, Journal of Health Politics, Policy, and Law, no. 7, pp. 440–59.Google Scholar
  67. Horowitz, I.L. (1965) The Three Worlds of Development, (New Brunswick, New Jersey: Transaction Books).Google Scholar
  68. Howard, L.M. (1981) ‘What Are the Financial Resources for “Health 2000?”’. World Health Forum. vol. 2. no. 1. pp. 23–9.Google Scholar
  69. Hunt, K. (1983) ‘DRG — What It Is, How It Works, and Why It Will Hurt’, Medical Economics, 5 September pp. 264–5.Google Scholar
  70. Illich, I. (1973) Medical Nemesis (Boston: Beacon Press).Google Scholar
  71. Jaggi, O.P. (1976) All About Allopathy, Homeopathy, Ayurveda, Unani, and Nature Cure (New Delhi: Orient Paperbacks).Google Scholar
  72. Jacques, E. (ed.), (1978) Health Services: Their Nature and Organisation and the Role of Patients, Doctors, Nurses, and the Complementary Professions (London: Heinemann).Google Scholar
  73. Jeffrey, R. (1976) ‘Health Care Delivery System: A Comment’, Economic and Political Weekly (10 July) pp. 1046–7.Google Scholar
  74. Johnson, R. (1982) ‘The State and the Professions: Peculiarities of the British’, in Giddins and Mackenzie, op. cit. , pp. 186–208.Google Scholar
  75. Kearney, R.N. (1973) The Politics of Ceylon (Sri Lanka), (Ithaca, New York: Cornell University Press).Google Scholar
  76. Kelman, S. (1977) ‘The Social Basis of the Definition of Health’, Internatio-nal Journal of Health Services, no. 6. pp. 217–47.Google Scholar
  77. Klein, R. (1977) ‘The Corporate State, Health Service, and the Professions’, New University Quarterly no. 31 pp 161–80Google Scholar
  78. Klein, R. (1983) The Politics of the National Health Service (London: Longmans).Google Scholar
  79. Klein, R. and J. Lewis, (1976) The Politics of Consumer Representation (London: Centre for Studies in Social Policy).Google Scholar
  80. Kohn, R. and K.L. White (eds), (1976) Health Care: An International Study (London: Oxford University Press).Google Scholar
  81. Krause, E. (1977) Power and Illness: The Political Sociology of Medical Care (New York: Elsevier).Google Scholar
  82. Lagergren, M. and K.E. Wictorsson, (1977) Case Study on Health Planning Organisation and Process in Sweden (Stockholm: Sjukvårdens och Social-vårdens Planerings och Rationaliserings Institut).Google Scholar
  83. Lebish, D.J. (1982) ‘PSROs and Utilisation Review: Life, Death, and Rebirth’, in Cleverly. op. cit.Google Scholar
  84. Leichter, H. (1979) A Comparative Approach to Policy Analysis: Health Care Policy in Four Nations (New York: Cambridge University Press).Google Scholar
  85. Leslie, C. (ed.) (1976) Asian Medical Systems: A Comparative Study (Berkeley: University of California Press).Google Scholar
  86. Levitt, R. (1977) The Reorganised National Health Service, 2nd edition (London: Croom Helm).Google Scholar
  87. Lindberg, L. et al. (eds), (1975) Stress and Contradiction in Modern Capitalism (Lexington, Massachusetts: Lexington Books).Google Scholar
  88. Luft, H.D. (1983) ‘Economic Incentives and Clinical Decisions’, in Gray, op. cit., pp. 103–23.Google Scholar
  89. McKinlay, J.B. (1982) ‘Toward the Proletarianisation of Physicians’, in Derber op. cit.. pp. 37–65.Google Scholar
  90. McLachlan, G. and A. Maynard (eds) (1982) The Public/Private Mix for Health (London: Nuffield Provincial Hospitals Trust)Google Scholar
  91. Mahler, H. (1977) ‘Blueprint for Health for All’, WHO Chronical, no. 31, pp. 491–8.Google Scholar
  92. Marmor, T.R. (1973) The Politics of Medicare (Chicago: Aldine Publishing Company).Google Scholar
  93. Marmor, T.R., (1980) A. Bridges and W. Hoffman, ‘Comparative Politics and Health Policies: Notes on Benefits, Costs, Limits’, in Ashford, op. cit., pp. 59–80.Google Scholar
  94. Marmor, T.R. and J.A. Morone, (1980) ‘Representing Consumer Interests: Imbalanced Markets, Health Planning, and the HSAs’, Health and Society: Milbank Memorial Fund Quarterly, no. 58, pp. 125–65.Google Scholar
  95. Marmor, T.R. and D. Thomas, (1972) ‘Doctors, Politics, and Pay Disputes: “Pressure Group Politics” Revisited’, British Journal of Political Science, no. 2. pp. 422–42.Google Scholar
  96. Maxwell, R. (1975) Health Care: The Growing Dilemma: Needs v. Resources in Western Europe, the US, and the USSR, 2nd edition (New York: McKinsey).Google Scholar
  97. Maxwell, R. (1981) Health and Wealth: An International Study of Health Care Spending, (Lexington, Massachusetts: Lexington Books).Google Scholar
  98. Mechanic, D. (1976) The Growth of Bureaucratic Medicine (New York: John Wiley and Sons).Google Scholar
  99. Mechanic, D. (1984) ‘The Transformation of Health Providers’, Health Affairs, no. 4, pp. 65 – 74.Google Scholar
  100. Morone, J.A. and A.B. Dunham, (1984) ‘DRGs and the Waning of Professional Dominance’, Health Affairs, no. 3, pp. 73–86.Google Scholar
  101. Mosher, F. (1978) ‘Professions in Public Service’, Public Administration Review no 38, pp. 144–50.Google Scholar
  102. Moskop, J.C. (1981) ‘The Nature and Limits of the Physicians’ Authority’, in Staum and Larson, loc. cit., pp. 29–43.Google Scholar
  103. Nayar, B.R. (1972) The Modernisation Imperative (New Delhi: Vikas Publications).Google Scholar
  104. Niessen, M. and J. Peschar (eds), (1982) International Comparative Research: Problems of Theory, Methodology, and Organisation in Eastern and Western Europe (Oxford: Pergamon Press, Ltd.).Google Scholar
  105. Poullier, J.J. (ed.) (1977) Public Expenditures on Health (Paris: OECD Studies in Resource Allocation, no. 4,).Google Scholar
  106. Przeworski, A. and H. Teune, (1970) The Logic of Comparative Social Inquiry (New York: Wiley-Interscience, John Wiley and Sons).Google Scholar
  107. Robson, J. (1973) ‘The NHS Company, Inc.? The Social Consequences of Professional Dominance in the National Health Service’, International Journal of Health Services, no. 3, pp. 413–26.Google Scholar
  108. Rodwin, V.G. (1981) ‘The Marriage of National Health Insurance and “La Médicine Libérale” in France: A Costly Union’, Health and Society: Milbank Memorial Quarterly no. 59, pp. 16–43.Google Scholar
  109. Rodwin, V.G. (1982) ‘Management Without Objectives: The French Health Policy Gamble’, in McLachlan and Maynard, op. cit.. pp. 289–325.Google Scholar
  110. Sharma, S.K. (ed.) (1977) Dynamics of Development: An International Perspective (New Delhi: Concept Publishing Company).Google Scholar
  111. Shenkin, B.N. (1973) ‘Politics and Medical Care in Sweden: The Seven Crowns Reform’ New England Journal of Medicine no. 288, pp. 555–9.Google Scholar
  112. Sidel, R. and V.W. Sidel, (1982) The Health of China: Current Conflicts in Medical and Human Services for One Billion People (Boston: Beacon Press).Google Scholar
  113. Silver, G.A. (1976) et al., Impact of Federal Health Policies in the States of Connecticut and Vermont (Springfield, Virginia: National Technical Information Service) (PB-262–959).Google Scholar
  114. Silvard, R.L. (1979) World Military and Social Expenditures 1979 (Leesburg, Virginia: World Priorities).Google Scholar
  115. Silvard, R.L. (1982) World Military and Social Expenditures 1982 , (Leesburg, Virginia: World Priorities)Google Scholar
  116. Silvard, R.L. (1986) World Military and Social Expenditures 1986, (Leesburg, Virginia: World Priorities).Google Scholar
  117. Starr, P. (1982) The Social Transformation of American Medicine (New York: Basic Books).Google Scholar
  118. Staum, M.S. and D.E. Larson (eds), (1981) Doctors, Patients, and Society, (Waterloo, Ontario: Wilfried Laurier University Press).Google Scholar
  119. Steffen, M. (1983) ‘Régulation Politique et Stratégiés Professionnelles: Médicine Libérale et Emergence des Centres de Santé’ (Grénoble: manuscript).Google Scholar
  120. Steudler, F. (1977) ‘Médicine Libérale et Conventionnement’, Sociologie du Travail, no. 17. pp. 176–98.Google Scholar
  121. Steudler, F. (1984) ‘State and Health in France’ (Paris: manuscript).Google Scholar
  122. Stone, D.A. (1980) The Limits of Professional Power: National Health Insurance in the Federal Republic of Germany (Chicago: University of Chicago Press).Google Scholar
  123. Szalai, A. and R. Petrella (eds), (1977) Cross-National Comparative Survey Research: Theory and Practice (Oxford: Pergamon Press. Ltd.).Google Scholar
  124. Taylor, R.C.R. (1984) ‘State Intervention in Postwar Western European Health Care: The Case of Prevention in Britain and Italy’, in Bornstein et al., op. cit., pp. 91–117.Google Scholar
  125. Tolliday, H. (1978) ‘Clinical Autonomy’, in Jacques, op. cit., pp. 32–52.Google Scholar
  126. Virgo, J.M. (ed.) (1984) Health Care: An International Perspective (Edward-sville, Illinois: International Health Economics and Management Institute).Google Scholar
  127. Walt, G. and P. Vaughn, (1981) An Introduction to the Primary Health Care Approach in Developing Countries (London: Ross Institute of Tropical Hygiene).Google Scholar
  128. Weller, G. and P. Manga, (1983) ‘The Push for Reprivatisation of Health Care Services in Canada, Britain, and the United States’, Journal of Health Politics, Policy, and Law, no. 8, pp. 495–518.Google Scholar
  129. Wiatr, J. (1977) ‘The Role of Theory in the Process of Cross-National Survey Research’, in Szalai and Petrella, op. cit., pp. 347–72.Google Scholar
  130. Wilsford, D. (1989) ‘Physicians and the State in France’, in Freddi and Björkman, op. cit., pp. 130–56.Google Scholar

Copyright information

© Christa Altenstetter and Stuart C. Haywood 1991

Authors and Affiliations

  • James W. Björkman

There are no affiliations available

Personalised recommendations