Download PDF by Carolyn Hughes Tuohy: Accidental Logics: The Dynamics of Change in the Health Care

By Carolyn Hughes Tuohy

ISBN-10: 0195128214

ISBN-13: 9780195128215

What drives switch in wellbeing and fitness care structures? Why do sure adjustments ensue in a few international locations and never in others? writer Carolyn Hughes Tuohy argues that the reply lies in figuring out the "accidents" of heritage that experience formed nationwide structures at severe moments, and within the detailed "logics" of those platforms. Tuohy seems to be on the studies of england, Canada, and the U.S., supplying a world comparative research of public coverage structures, in addition to a contemporary historical past of the situations in every one nation that experience impacted at the buildings of each's nationwide overall healthiness care procedure. The guiding concentration of the ebook is Tuohy's research of choice making structures in each one kingdom, taking a look at the choices made via those that offer, finance, and use future health care companies. eventually, Tuohy stories present concerns within the health and wellbeing care arenas of those 3 countries and offers feedback to lead the strategic judgments that decision-makers needs to make.

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For an individual consumer, the marginal costs of acquiring the necessary information in his or her particular case would be extremely costly or infeasible. Furthermore, it is difficult for the consumer to evaluate the quality of the service offered by competing practitioners, at least until possibly irreversible results have occurred. Because the outcome of treatment in any given case depends on a number of factors beyond the care provided (including, as Fuchs [1993: 34] has pointed out, the patient's own "knowledge, skill and motivation and the level of trust between patient and physician") it would again be very costly or infeasible for an individual patient to "shop" for care by investigating the experience of other patients in similar situations.

Under the emerging paradigm, the financing and purchasing functions could be combined, as in the case of the acute care hospital sector in Canada and Germany and (under the 1990s reforms) in Britain, Sweden, and New Zealand in which state agencies negotiated "global budgets" or "contracts" with independently constituted hospitals. S. 9 Alternatively, the purchasing and providing functions could be combined. The primary examples of such a combination were health maintenance organizations (HMOs) in the United States, which undertook to "manage" all the care required by an individual for a prepaid annual fee.

The model of an integrated geographically based hierarchy for health care financing and delivery also developed in different variants in Ireland, the Scandinavian countries, and New Zealand, and through the transformation of the corporatist social insurance systems of Italy, Portugal, and Spain in the 1970s and 1980s (Elola 1996; Flood 1996; Ferrara 1995; Rodriguez 1995). Each of these national systems also accorded varying degrees of weight to other sets of actors and instruments as well: all, for example, continued to allow for various admixtures of public and private finance through copayments or parallel private sectors.

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Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada by Carolyn Hughes Tuohy


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