Debra L. Dodson
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780198296744
- eISBN:
- 9780191603709
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0198296746.003.0013
- Subject:
- Political Science, Comparative Politics
The story of health insurance reform in the 104th brings to life many of the contested issues surrounding gender difference in impact. It illustrates the importance of going beyond quantitative ...
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The story of health insurance reform in the 104th brings to life many of the contested issues surrounding gender difference in impact. It illustrates the importance of going beyond quantitative evidence of gender difference to look carefully at the substance of those differences that emerge, to understand their relationship to the broader political context, and to explicitly consider the motivations belying difference. That those who were seen as advocates for women in the health care reform battles of the 103rd played little role in health insurance reform, while some of the more visible vocal women critics of the Clinton plan led the effort some saw as ‘radical’, that the prime [female] motivator and facilitator of the effort was not seen as driven by gendered forces or even connected with women’s organizations, and that Republican women who had supported women’s health also supported a measure likely to have reversed state mandates protecting women’s health benefits all make health insurance reform a unique laboratory for addressing the contested issues that surround difference. The conclusions suggest a growing gap between gender difference and the standards of third wave feminism, the need for an active engaged women’s movement to counter the threat posed by essentialist assumptions that grant legitimacy to any pronouncement women make on behalf of women, the contribution differences in the masculinist cultures of parties may make toward partisan differences in the manifestation of feminist protest, and they caution against the gendered consequences of ostensibly gender-neutral institutional procedures.Less
The story of health insurance reform in the 104th brings to life many of the contested issues surrounding gender difference in impact. It illustrates the importance of going beyond quantitative evidence of gender difference to look carefully at the substance of those differences that emerge, to understand their relationship to the broader political context, and to explicitly consider the motivations belying difference. That those who were seen as advocates for women in the health care reform battles of the 103rd played little role in health insurance reform, while some of the more visible vocal women critics of the Clinton plan led the effort some saw as ‘radical’, that the prime [female] motivator and facilitator of the effort was not seen as driven by gendered forces or even connected with women’s organizations, and that Republican women who had supported women’s health also supported a measure likely to have reversed state mandates protecting women’s health benefits all make health insurance reform a unique laboratory for addressing the contested issues that surround difference. The conclusions suggest a growing gap between gender difference and the standards of third wave feminism, the need for an active engaged women’s movement to counter the threat posed by essentialist assumptions that grant legitimacy to any pronouncement women make on behalf of women, the contribution differences in the masculinist cultures of parties may make toward partisan differences in the manifestation of feminist protest, and they caution against the gendered consequences of ostensibly gender-neutral institutional procedures.
Debra L. Dodson
- Published in print:
- 2006
- Published Online:
- May 2006
- ISBN:
- 9780198296744
- eISBN:
- 9780191603709
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0198296746.003.0012
- Subject:
- Political Science, Comparative Politics
This chapter deconstructs gender differences to explore the contested issues surrounding gender difference, when the politics of presence converged with partisan politics in the struggle over health ...
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This chapter deconstructs gender differences to explore the contested issues surrounding gender difference, when the politics of presence converged with partisan politics in the struggle over health care reform during the Democratic-controlled 103rd Congress. The impact of the institutional environment on women’s agenda and actions, along with differences in environmental pressures across parties and committees, are explored. The analysis attempts to move beyond the simple question of whether women make a difference to an understanding of how political environments, structured by partisanship and steeped in masculinist values, affect and can be affected by the feminale. The case study suggests that one cannot truly understand gender differences in an institutional vacuum, even as it forces us to confront the relationship between gender difference and substantive representation of women, and to consider the value of the concept of feminist protest in understanding partisan differences in gender difference and women’s impact.Less
This chapter deconstructs gender differences to explore the contested issues surrounding gender difference, when the politics of presence converged with partisan politics in the struggle over health care reform during the Democratic-controlled 103rd Congress. The impact of the institutional environment on women’s agenda and actions, along with differences in environmental pressures across parties and committees, are explored. The analysis attempts to move beyond the simple question of whether women make a difference to an understanding of how political environments, structured by partisanship and steeped in masculinist values, affect and can be affected by the feminale. The case study suggests that one cannot truly understand gender differences in an institutional vacuum, even as it forces us to confront the relationship between gender difference and substantive representation of women, and to consider the value of the concept of feminist protest in understanding partisan differences in gender difference and women’s impact.
Susan Giaimo
- Published in print:
- 2001
- Published Online:
- November 2003
- ISBN:
- 9780198297567
- eISBN:
- 9780191600104
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/0198297564.003.0012
- Subject:
- Political Science, Comparative Politics
In this second of three chapters on the distinctive policy dynamics of particular areas of social provision, Susan Giaimo addresses the issue of whether the success of the reformed welfare state in ...
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In this second of three chapters on the distinctive policy dynamics of particular areas of social provision, Susan Giaimo addresses the issue of whether the success of the reformed welfare state in the shape of payers’ and policy makers’ cost‐containment projects have had as their price the sacrifice of equity and solidarity. These questions are explored through the lens of health care reform in Britain, Germany, and the US since the late 1980s: each a country with a distinctive health care system, which undertook major reform initiatives designed to control health care outlays, and addressed the efficiency and equity goals in markedly different ways. Section I provides a broad background to situate the contemporary politics of health care reform, explaining how and why health care systems in Western countries have come under the stress of increasing cost pressures even as governments and employers have become more apprehensive about the possible effects of the welfare state on economic competitiveness. Section 2 develops the argument in greater depth, explaining how existing health care and political systems provide different opportunities or constraints for payers and the state to pursue unilateral cost‐containment strategies, how health care institutions themselves shape policy preferences and strategies of payers, and how some systems require compromise solutions that reconcile equity with efficiency. Section 3 presents each country's case, and the concluding section considers the broader lessons from health care reform for the contemporary politics of welfare state adjustment.Less
In this second of three chapters on the distinctive policy dynamics of particular areas of social provision, Susan Giaimo addresses the issue of whether the success of the reformed welfare state in the shape of payers’ and policy makers’ cost‐containment projects have had as their price the sacrifice of equity and solidarity. These questions are explored through the lens of health care reform in Britain, Germany, and the US since the late 1980s: each a country with a distinctive health care system, which undertook major reform initiatives designed to control health care outlays, and addressed the efficiency and equity goals in markedly different ways. Section I provides a broad background to situate the contemporary politics of health care reform, explaining how and why health care systems in Western countries have come under the stress of increasing cost pressures even as governments and employers have become more apprehensive about the possible effects of the welfare state on economic competitiveness. Section 2 develops the argument in greater depth, explaining how existing health care and political systems provide different opportunities or constraints for payers and the state to pursue unilateral cost‐containment strategies, how health care institutions themselves shape policy preferences and strategies of payers, and how some systems require compromise solutions that reconcile equity with efficiency. Section 3 presents each country's case, and the concluding section considers the broader lessons from health care reform for the contemporary politics of welfare state adjustment.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0004
- Subject:
- Political Science, American Politics
This chapter examines the ideational and political movements advocating market-based forms of delegated governance since the 1970s. In part, the embrace of marketizing reforms reflected the ...
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This chapter examines the ideational and political movements advocating market-based forms of delegated governance since the 1970s. In part, the embrace of marketizing reforms reflected the refinement of ideas about the inefficient and oppressive nature of government as juxtaposed with the dynamism, efficiency, and liberating qualities of markets and individual choice. Some conservative and centrist policy-makers also believed the American state was inherently weak—a self-fulfilling prophecy given their longstanding resistance to building effective bureaucratic capacity at the federal level. In a context of rising health care costs, some policy-makers sought ways to make private insurers do the tough work of disciplining health care interests, delegating to these non-governmental authorities responsibility for meting out pain to medical providers. We trace this impulse through the push for allowing HMOs to administer Medicare benefits; the gathering enthusiasm for managed competition and the Clinton health care reform effort of 1993/94; proposals that emerged in the 1990s for complete Medicare voucherization; and the movement for Health Savings Accounts.Less
This chapter examines the ideational and political movements advocating market-based forms of delegated governance since the 1970s. In part, the embrace of marketizing reforms reflected the refinement of ideas about the inefficient and oppressive nature of government as juxtaposed with the dynamism, efficiency, and liberating qualities of markets and individual choice. Some conservative and centrist policy-makers also believed the American state was inherently weak—a self-fulfilling prophecy given their longstanding resistance to building effective bureaucratic capacity at the federal level. In a context of rising health care costs, some policy-makers sought ways to make private insurers do the tough work of disciplining health care interests, delegating to these non-governmental authorities responsibility for meting out pain to medical providers. We trace this impulse through the push for allowing HMOs to administer Medicare benefits; the gathering enthusiasm for managed competition and the Clinton health care reform effort of 1993/94; proposals that emerged in the 1990s for complete Medicare voucherization; and the movement for Health Savings Accounts.
Kimberly J. Morgan and Andrea Louise Campbell
- Published in print:
- 2011
- Published Online:
- January 2012
- ISBN:
- 9780199730346
- eISBN:
- 9780199918447
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199730346.003.0009
- Subject:
- Political Science, American Politics
This chapter summarizes the book’s main findings and probes its larger implications. The book has not only shed light on an important episode in American politics, but advanced our thinking about the ...
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This chapter summarizes the book’s main findings and probes its larger implications. The book has not only shed light on an important episode in American politics, but advanced our thinking about the complex realities of the American state. A second set of implications has to do with the nature of redistributive policy in the United States, which some would argue has been captured by well-heeled interests and become increasingly unresponsive to mass opinion. To the contrary, the book has argued that because the public sends fundamentally contradictory signals to American politicians about what the role of government should be in their lives, delegated arrangements often reflect the views of an ambivalent public. Moreover, because deeply-rooted ideational and institutional forces have driven the recourse to these kinds of governing arrangements again and again, one can expect this pattern to continue in the foreseeable future. To show this, the book ends with a brief examination of the 2009-2010 health care reform effort in which both the fight over the appropriate scope and power of the federal government and the solution—delegation to private health insurers and states—reflect the political forces traced in this book.Less
This chapter summarizes the book’s main findings and probes its larger implications. The book has not only shed light on an important episode in American politics, but advanced our thinking about the complex realities of the American state. A second set of implications has to do with the nature of redistributive policy in the United States, which some would argue has been captured by well-heeled interests and become increasingly unresponsive to mass opinion. To the contrary, the book has argued that because the public sends fundamentally contradictory signals to American politicians about what the role of government should be in their lives, delegated arrangements often reflect the views of an ambivalent public. Moreover, because deeply-rooted ideational and institutional forces have driven the recourse to these kinds of governing arrangements again and again, one can expect this pattern to continue in the foreseeable future. To show this, the book ends with a brief examination of the 2009-2010 health care reform effort in which both the fight over the appropriate scope and power of the federal government and the solution—delegation to private health insurers and states—reflect the political forces traced in this book.
Mark A. Peterson
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195170665
- eISBN:
- 9780199850204
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195170665.003.0036
- Subject:
- Political Science, American Politics
This chapter argues that Congress may be called the graveyard of major health reforms. It begins by examining the institutional setting of U.S. governance in which Congress is embedded and highlights ...
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This chapter argues that Congress may be called the graveyard of major health reforms. It begins by examining the institutional setting of U.S. governance in which Congress is embedded and highlights the challenges this generally poses for large-scale policy making compared with of other countries. The chapter then examines the problem of coalition building in legislatures to illustrate the challenges and opportunities engendered by Congress in the twentieth century. It highlights the manner in which the system's institutional features and health-care politics have changed over time, creating different opportunities for coalition building, and then explains why those opportunities have been missed or ineffectively pursued. The chapter concludes with some ideas for enhancing future opportunities to enact universal coverage.Less
This chapter argues that Congress may be called the graveyard of major health reforms. It begins by examining the institutional setting of U.S. governance in which Congress is embedded and highlights the challenges this generally poses for large-scale policy making compared with of other countries. The chapter then examines the problem of coalition building in legislatures to illustrate the challenges and opportunities engendered by Congress in the twentieth century. It highlights the manner in which the system's institutional features and health-care politics have changed over time, creating different opportunities for coalition building, and then explains why those opportunities have been missed or ineffectively pursued. The chapter concludes with some ideas for enhancing future opportunities to enact universal coverage.
Jennifer Prah Ruger
- Published in print:
- 2009
- Published Online:
- February 2010
- ISBN:
- 9780199559978
- eISBN:
- 9780191721489
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199559978.003.0010
- Subject:
- Economics and Finance, Public and Welfare
Many countries, including the United States, lack consensus about the core ethical principles concerning health and health care, beyond a market‐based approach to resource allocation. This chapter ...
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Many countries, including the United States, lack consensus about the core ethical principles concerning health and health care, beyond a market‐based approach to resource allocation. This chapter offers a normative theory for analyzing health policy decisions and recognizes that norms need fundamental restructuring to address existing health problems. Substantive normative principles (moral legitimacy) should be introduced into deliberative democratic process (political legitimacy) for a comprehensive, integrative theory of health and social justice. The chapter reviews the role of moral values in motivating citizens' support for public policies, and explores differences between social agreement frameworks such as incompletely theorized agreements (ITAs) and overlapping consensus and more traditional political bargaining models. ITA analysis of the American Clinton health care reform attempts reveals agreement on the mid‐level concept of universal coverage, but disagreement on both high‐ and low‐level principles. The chapter concludes that high‐level principle (e.g. health for all) or low‐level principle (e.g. willingness to pay for other's and future selves' health insurance) agreement, arising from internalization of shared public moral norms, might lead to more stable support for reform.Less
Many countries, including the United States, lack consensus about the core ethical principles concerning health and health care, beyond a market‐based approach to resource allocation. This chapter offers a normative theory for analyzing health policy decisions and recognizes that norms need fundamental restructuring to address existing health problems. Substantive normative principles (moral legitimacy) should be introduced into deliberative democratic process (political legitimacy) for a comprehensive, integrative theory of health and social justice. The chapter reviews the role of moral values in motivating citizens' support for public policies, and explores differences between social agreement frameworks such as incompletely theorized agreements (ITAs) and overlapping consensus and more traditional political bargaining models. ITA analysis of the American Clinton health care reform attempts reveals agreement on the mid‐level concept of universal coverage, but disagreement on both high‐ and low‐level principles. The chapter concludes that high‐level principle (e.g. health for all) or low‐level principle (e.g. willingness to pay for other's and future selves' health insurance) agreement, arising from internalization of shared public moral norms, might lead to more stable support for reform.
Theodore R. Marmor, Richard Freeman, and Kieke G. H. Okma
- Published in print:
- 2009
- Published Online:
- October 2013
- ISBN:
- 9780300149838
- eISBN:
- 9780300155952
- Item type:
- book
- Publisher:
- Yale University Press
- DOI:
- 10.12987/yale/9780300149838.001.0001
- Subject:
- Political Science, Comparative Politics
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 ...
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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 also across the world.Less
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 also across the world.
Jill Quadagno
- Published in print:
- 2006
- Published Online:
- May 2012
- ISBN:
- 9780195160390
- eISBN:
- 9780199944026
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195160390.003.0009
- Subject:
- Sociology, Race and Ethnicity
This chapter presents an evaluation of the alternative explanations of the American case based on the historical evidence given, and analyzes the prospects of health care reform in the twentieth ...
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This chapter presents an evaluation of the alternative explanations of the American case based on the historical evidence given, and analyzes the prospects of health care reform in the twentieth century. It also argues that the United States does not have the health care system it needs due to the failure of its citizens to realize how much they have ceded their health care to private interests, and also reviews the theories of the welfare state.Less
This chapter presents an evaluation of the alternative explanations of the American case based on the historical evidence given, and analyzes the prospects of health care reform in the twentieth century. It also argues that the United States does not have the health care system it needs due to the failure of its citizens to realize how much they have ceded their health care to private interests, and also reviews the theories of the welfare state.
Andrew Green
- Published in print:
- 2007
- Published Online:
- September 2009
- ISBN:
- 9780198571346
- eISBN:
- 9780191724138
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780198571346.003.0003
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This chapter traces some of the key policy themes that have been central to the health sector over the last twenty years. It begins by examining the policy of primary health care (PHC), which for ...
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This chapter traces some of the key policy themes that have been central to the health sector over the last twenty years. It begins by examining the policy of primary health care (PHC), which for many countries was the foundation of their health policies in the 1980s. In the 1990s, emphasis shifted away from PHC towards issues related to the structure of the health sector. Health sector reform (HSR) or health system development (HSD) policies (as they are now more commonly known) have become a major concern of many external partners and health ministries; the chapter examines the key elements of these that were promoted in the 1990s and subsequently. The post-millennium period and a number of more recent policy issues and developments are considered, including increased globalization and the focus on human resources. The chapter concludes by looking at the implications of these policies for effective health planning.Less
This chapter traces some of the key policy themes that have been central to the health sector over the last twenty years. It begins by examining the policy of primary health care (PHC), which for many countries was the foundation of their health policies in the 1980s. In the 1990s, emphasis shifted away from PHC towards issues related to the structure of the health sector. Health sector reform (HSR) or health system development (HSD) policies (as they are now more commonly known) have become a major concern of many external partners and health ministries; the chapter examines the key elements of these that were promoted in the 1990s and subsequently. The post-millennium period and a number of more recent policy issues and developments are considered, including increased globalization and the focus on human resources. The chapter concludes by looking at the implications of these policies for effective health planning.
Craig R. Janes
- Published in print:
- 2009
- Published Online:
- September 2009
- ISBN:
- 9780195374643
- eISBN:
- 9780199865390
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195374643.003.0024
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
Globally, post-Alma Ata health care system reforms have included reorganization of government health agencies, establishment of rationalized, evidence-based systems of care, implementation of user ...
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Globally, post-Alma Ata health care system reforms have included reorganization of government health agencies, establishment of rationalized, evidence-based systems of care, implementation of user charges for public services, and experiments with third party financing. Drawing on materials collected in the context of long-term ethnographic research in Mongolia, this chapter reveals that there is a mismatch between the economic rationality that underlies current health reform programs and the realities of the lived experiences of illness in poor communities. Coupled with decentralization and poor regulatory oversight, current health reform efforts can result in fragmentation of the health system, increasing opportunity costs for health care seeking by poor households, reduced access to essential drugs, and an overall increased risk for health-cost related impoverishment. The chapter concludes by arguing that ethnographic information on health care seeking in poor communities can inform health reform efforts through explaining how features of health reform produce health inequities.Less
Globally, post-Alma Ata health care system reforms have included reorganization of government health agencies, establishment of rationalized, evidence-based systems of care, implementation of user charges for public services, and experiments with third party financing. Drawing on materials collected in the context of long-term ethnographic research in Mongolia, this chapter reveals that there is a mismatch between the economic rationality that underlies current health reform programs and the realities of the lived experiences of illness in poor communities. Coupled with decentralization and poor regulatory oversight, current health reform efforts can result in fragmentation of the health system, increasing opportunity costs for health care seeking by poor households, reduced access to essential drugs, and an overall increased risk for health-cost related impoverishment. The chapter concludes by arguing that ethnographic information on health care seeking in poor communities can inform health reform efforts through explaining how features of health reform produce health inequities.
Marc J. Roberts, William Hsiao, Peter Berman, and Michael R. Reich
- Published in print:
- 2008
- Published Online:
- September 2009
- ISBN:
- 9780195371505
- eISBN:
- 9780199863839
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195371505.003.0004
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This chapter addresses the question of how health reformers should develop and carry out political strategies in order to improve the chances that their plan will be adopted and put into action. It ...
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This chapter addresses the question of how health reformers should develop and carry out political strategies in order to improve the chances that their plan will be adopted and put into action. It begins by examining how the agenda is set for public policy in general and for health-sector reform in particular. It then discusses how to manage this process of agenda-setting, through the use of stakeholder analysis. It presents four basic political strategies for improving the chances that a policy reform will be adopted, concluding with lessons from negotiation theory about how to build a winning political coalition. Finally, it discusses some of the ethical dimensions of political strategizing, including the personal decisions faced by health reformers.Less
This chapter addresses the question of how health reformers should develop and carry out political strategies in order to improve the chances that their plan will be adopted and put into action. It begins by examining how the agenda is set for public policy in general and for health-sector reform in particular. It then discusses how to manage this process of agenda-setting, through the use of stakeholder analysis. It presents four basic political strategies for improving the chances that a policy reform will be adopted, concluding with lessons from negotiation theory about how to build a winning political coalition. Finally, it discusses some of the ethical dimensions of political strategizing, including the personal decisions faced by health reformers.
Marc Roberts, William Hsiao, Peter Berman, and Michael Reich
- Published in print:
- 2008
- Published Online:
- September 2009
- ISBN:
- 9780195371505
- eISBN:
- 9780199863839
- Item type:
- book
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195371505.001.0001
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This book provides a framework for developing and analyzing health sector reforms, based on international experience. It offers practical guidance and stresses the need to take account of each ...
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This book provides a framework for developing and analyzing health sector reforms, based on international experience. It offers practical guidance and stresses the need to take account of each country's economic, administrative, and political circumstances. The book explains how to design effective government interventions in five areas—financing, payment, organization, regulation, and behavior—to improve the performance and equity of health systems around the world. There are a number of critical features in the book's approach to health-sector reform. The first is to see the health sector as a means to an end. Reformers should judge their systems by the consequences, to define problems in terms of performance deficiencies, and to assess proposed solutions by whether they promise to remedy those deficiencies. This approach leads to an analytically rigorous method for problem definition, causal diagnosis, and policy development. This kind of method has often been lacking in health reforms efforts, and its lack is partially responsible for the disappointing results. A second major feature of the book's approach is a commitment to combining international experience with deep sensitivity to local circumstances. A third feature of this study is that the book puts forward a multidisciplinary approach to the problems of health-sector reform. Finally, the book argues that health-sector policy inevitably involves ethical choices.Less
This book provides a framework for developing and analyzing health sector reforms, based on international experience. It offers practical guidance and stresses the need to take account of each country's economic, administrative, and political circumstances. The book explains how to design effective government interventions in five areas—financing, payment, organization, regulation, and behavior—to improve the performance and equity of health systems around the world. There are a number of critical features in the book's approach to health-sector reform. The first is to see the health sector as a means to an end. Reformers should judge their systems by the consequences, to define problems in terms of performance deficiencies, and to assess proposed solutions by whether they promise to remedy those deficiencies. This approach leads to an analytically rigorous method for problem definition, causal diagnosis, and policy development. This kind of method has often been lacking in health reforms efforts, and its lack is partially responsible for the disappointing results. A second major feature of the book's approach is a commitment to combining international experience with deep sensitivity to local circumstances. A third feature of this study is that the book puts forward a multidisciplinary approach to the problems of health-sector reform. Finally, the book argues that health-sector policy inevitably involves ethical choices.
David A. Leon and Gill Walt
- Published in print:
- 2000
- Published Online:
- September 2009
- ISBN:
- 9780192631961
- eISBN:
- 9780191723599
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780192631961.003.0009
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This chapter considers the role of health care systems in generating poverty and inequality. It argues that health care systems, as social institutions, are built out of the existing social structure ...
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This chapter considers the role of health care systems in generating poverty and inequality. It argues that health care systems, as social institutions, are built out of the existing social structure and carry its inequalities within them. However, health care systems are also a key site for contestation of existing inequality: they offer a representation back to us of our societies' capacity for care, and a public space for reworking those capacities. Effective health care reform that seeks to make the social institutions of health care more equitable must draw from an effective theory of health care system/inequality interaction. An approach to conceptualizing health care reform is presented.Less
This chapter considers the role of health care systems in generating poverty and inequality. It argues that health care systems, as social institutions, are built out of the existing social structure and carry its inequalities within them. However, health care systems are also a key site for contestation of existing inequality: they offer a representation back to us of our societies' capacity for care, and a public space for reworking those capacities. Effective health care reform that seeks to make the social institutions of health care more equitable must draw from an effective theory of health care system/inequality interaction. An approach to conceptualizing health care reform is presented.
Robert I. Field
- Published in print:
- 2013
- Published Online:
- January 2014
- ISBN:
- 9780199746750
- eISBN:
- 9780199354528
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780199746750.003.0008
- Subject:
- Public Health and Epidemiology, Public Health
The Affordable Care Act (ACA) culminated a century of efforts to achieve universal health coverage. They increasingly focused on market approaches, and the ACA followed this trend by relying on ...
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The Affordable Care Act (ACA) culminated a century of efforts to achieve universal health coverage. They increasingly focused on market approaches, and the ACA followed this trend by relying on private insurance companies to expand coverage. It facilitates a market for individual policies and expands Medicaid, which is widely administered by private plans. Obama garnered political supportfor the law through alliances with key industry sectors that stood to gain, including insurers, hospitals, physicians, and pharmaceutical firms. The ACA thereby extends to new lengths the public-private partnership underlying all American health care. Future reforms should address the partnership’s most glaring failings. These would transition reimbursement from fee-for-service to bundled payments, reduce administrative complexity, limit medicine’s specialist tilt, lessen the profession’s commercialization, and control the proliferation of expensive technology. Government activism created American health care, and it will always be the essential force in keeping it sustainable andvibrant.Less
The Affordable Care Act (ACA) culminated a century of efforts to achieve universal health coverage. They increasingly focused on market approaches, and the ACA followed this trend by relying on private insurance companies to expand coverage. It facilitates a market for individual policies and expands Medicaid, which is widely administered by private plans. Obama garnered political supportfor the law through alliances with key industry sectors that stood to gain, including insurers, hospitals, physicians, and pharmaceutical firms. The ACA thereby extends to new lengths the public-private partnership underlying all American health care. Future reforms should address the partnership’s most glaring failings. These would transition reimbursement from fee-for-service to bundled payments, reduce administrative complexity, limit medicine’s specialist tilt, lessen the profession’s commercialization, and control the proliferation of expensive technology. Government activism created American health care, and it will always be the essential force in keeping it sustainable andvibrant.
Jonathan H. Adler
- Published in print:
- 2015
- Published Online:
- May 2016
- ISBN:
- 9780226254951
- eISBN:
- 9780226255002
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226255002.003.0003
- Subject:
- Law, Medical Law
This chapter outlines how litigation in federal court will affect the implementation and viability of the Affordable Care Act (PPACA). The ACA's statutory language and administrative fixes complicate ...
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This chapter outlines how litigation in federal court will affect the implementation and viability of the Affordable Care Act (PPACA). The ACA's statutory language and administrative fixes complicate the implementation of health insurance exchanges. The requirement that group insurance plans include coverage for contraception also spurs litigation. Challenges to ACA provisions to control health care costs may create another battle over health care reform as the Independent Payment Advisory Board's unique structure and authority raise constitutional questions that may need to be resolved by federal courts. Finally, the Supreme Court's upholding of the imposition of a tax penalty on individuals who fail to obtain qualifying health insurance coverage under the individual mandate may have constrained the federal government's ability to use this penalty as a means of combating adverse selection in health insurance markets and exposed future reforms to the threat of further legal challenge.Less
This chapter outlines how litigation in federal court will affect the implementation and viability of the Affordable Care Act (PPACA). The ACA's statutory language and administrative fixes complicate the implementation of health insurance exchanges. The requirement that group insurance plans include coverage for contraception also spurs litigation. Challenges to ACA provisions to control health care costs may create another battle over health care reform as the Independent Payment Advisory Board's unique structure and authority raise constitutional questions that may need to be resolved by federal courts. Finally, the Supreme Court's upholding of the imposition of a tax penalty on individuals who fail to obtain qualifying health insurance coverage under the individual mandate may have constrained the federal government's ability to use this penalty as a means of combating adverse selection in health insurance markets and exposed future reforms to the threat of further legal challenge.
Marc J. Roberts, William Hsiao, Peter Berman, and Michael R. Reich
- Published in print:
- 2008
- Published Online:
- September 2009
- ISBN:
- 9780195371505
- eISBN:
- 9780199863839
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195371505.003.0002
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This chapter provides an introduction to the policy cycle for health-sector reform. It discusses the six stages of the process: problem definition, diagnosis, policy development, political decision, ...
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This chapter provides an introduction to the policy cycle for health-sector reform. It discusses the six stages of the process: problem definition, diagnosis, policy development, political decision, implementation, and evaluation.Less
This chapter provides an introduction to the policy cycle for health-sector reform. It discusses the six stages of the process: problem definition, diagnosis, policy development, political decision, implementation, and evaluation.
Marc J. Roberts, William Hsiao, Peter Berman, and Michael R. Reich
- Published in print:
- 2008
- Published Online:
- September 2009
- ISBN:
- 9780195371505
- eISBN:
- 9780199863839
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195371505.003.0010
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This chapter considers how government can influence the organization of the health-care delivery system. It begins by defining the meaning of “an organization”—as a provider of health-care ...
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This chapter considers how government can influence the organization of the health-care delivery system. It begins by defining the meaning of “an organization”—as a provider of health-care services—and that of “the organization of the system.” It then describes three kinds of interventions: changes in who-does-what, changes in incentives, and managerial changes, and discusses how they can improve overall performance. These interventions must work together; incentive changes like decentralization or contracting will not alter outcomes unless accompanied by changes at the managerial level. Similarly, the potential cost savings and clinical quality gains from changing scale and scope will only be realized if managers take advantage of their opportunities. Ultimately, the behavior of front-line workers and their managers has to be changed to produce real improvement.Less
This chapter considers how government can influence the organization of the health-care delivery system. It begins by defining the meaning of “an organization”—as a provider of health-care services—and that of “the organization of the system.” It then describes three kinds of interventions: changes in who-does-what, changes in incentives, and managerial changes, and discusses how they can improve overall performance. These interventions must work together; incentive changes like decentralization or contracting will not alter outcomes unless accompanied by changes at the managerial level. Similarly, the potential cost savings and clinical quality gains from changing scale and scope will only be realized if managers take advantage of their opportunities. Ultimately, the behavior of front-line workers and their managers has to be changed to produce real improvement.
Marc J. Roberts, William Hsiao, Peter Berman, and Michael R. Reich
- Published in print:
- 2008
- Published Online:
- September 2009
- ISBN:
- 9780195371505
- eISBN:
- 9780199863839
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195371505.003.0001
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
This introductory chapter discusses health sector reform. It argues that economic, social, and political forces, both inside and outside the health-care system, are causing widespread pressures to ...
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This introductory chapter discusses health sector reform. It argues that economic, social, and political forces, both inside and outside the health-care system, are causing widespread pressures to spend more on health care. New technologies (including new drugs) as well as changes in population structure and disease patterns are continuing to push up per capita health-care costs. The evolving international economic system often limits the capacity of governments and the private sector to meet these higher costs, especially in poor countries, because of short-term crises and longer-term competitive pressures. Broad shifts in intellectual beliefs about the state and the market have led to widespread promotion of market competition and privatization as solutions for all economic problems, including policies for the health sector.Less
This introductory chapter discusses health sector reform. It argues that economic, social, and political forces, both inside and outside the health-care system, are causing widespread pressures to spend more on health care. New technologies (including new drugs) as well as changes in population structure and disease patterns are continuing to push up per capita health-care costs. The evolving international economic system often limits the capacity of governments and the private sector to meet these higher costs, especially in poor countries, because of short-term crises and longer-term competitive pressures. Broad shifts in intellectual beliefs about the state and the market have led to widespread promotion of market competition and privatization as solutions for all economic problems, including policies for the health sector.
Marc J. Roberts, William Hsiao, Peter Berman, and Michael R. Reich
- Published in print:
- 2008
- Published Online:
- September 2009
- ISBN:
- 9780195371505
- eISBN:
- 9780199863839
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195371505.003.0007
- Subject:
- Public Health and Epidemiology, Public Health, Epidemiology
Once health-sector reformers have decided which performance problems to focus on—that is, once they have decided on their strategic priorities—they have to go on to the next stages of the policy ...
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Once health-sector reformers have decided which performance problems to focus on—that is, once they have decided on their strategic priorities—they have to go on to the next stages of the policy cycle. This means, first of all, figuring out the causes of the poor performance they are concerned with—a process called “diagnosis.” Then they have to decide what to do about the situation—the process called “policy development.” This chapter discusses those activities and offers advice about how to carry them out, so as to produce more effective health-sector reform.Less
Once health-sector reformers have decided which performance problems to focus on—that is, once they have decided on their strategic priorities—they have to go on to the next stages of the policy cycle. This means, first of all, figuring out the causes of the poor performance they are concerned with—a process called “diagnosis.” Then they have to decide what to do about the situation—the process called “policy development.” This chapter discusses those activities and offers advice about how to carry them out, so as to produce more effective health-sector reform.
