Health care reform as a political process. Some remarks on selected clues
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Instytut Zdrowia Publicznego Collegium Medicum Uniwersytetu Jagiellońskiego
Publication date: 2020-06-08
Problemy Polityki Społecznej 2002;4:33–57
Health sectors (systems) have always been undergoing many changes But in late eighteens changes were intensified and looked at as something specific and referred to as “health reforms” . Though changes considered and implemented in different countries varied, most observers underlined the similarities occurring in reforms, especially in industrialized countries. In this paper reforms in United Kingdom , Sweden and New Zealand are analyzed. In early nineties all these countries had comprehensive health systems, emphasizing the rule of public responsibility. All made decision to implement a number of market-oriented mechanisms, relying on concepts of internal market, competition, provider-purchaser split and appreciating the role of private sector. The reforms resulted in limited successes but were abandoned after shorter or longer periods. All countries gave up market slogans and returned to rules of public (state’s) responsibility, even if solutions that proved efficient were preserved. A question on factors contributing to two problems is posed. First, why market-oriented solutions were accepted and implem ented so easily and broadly. Second, why market-oriented solutions, once in use, were so willingly rejected. My hypothesis is that the answers should be sought in characteristics of political process in which health reform was being prepared and implemented.