Paths of Progress in Healthcare Reform: The Scale and Pace of Change in Four Advanced Nations

52 Pages Posted: 19 Jul 2010 Last revised: 12 Jul 2011

See all articles by Carolyn Hughes Tuohy

Carolyn Hughes Tuohy

University of Toronto - Department of Political Science

Date Written: August 28, 2010

Abstract

In the past two decades, three cases of major change in health policy frameworks in advanced nations stand out in comparative perspective: the British “internal market” reforms of the 1990s, the Dutch introduction of universal managed competition among insurers in 2006, and the enactment of a universal mandate for health insurance in the US. Each of these cases represents a substantial shift from the foundational model of the nation’s health care state, either on a large scale, at a rapid pace, or both. The intersection of these two dimensions of scale and pace yields four possible strategies for policy change: big-bang (exhibited by the UK), blueprint (the Netherlands), mosaic (US) and, by default, incremental (exhibited in the current study by the case of Canada). These respective strategies can be understood as the result of judgments made by key actors under particular circumstances in the broader political and institutional context in each nation. Rare conjunctures of forces exogenous to the health care arena create opportunities for major change, but favour different strategies in different contexts. In the absence of such conjunctures, tensions inherent to health care delivery drive a pattern of cycling through established policy repertoires.

Suggested Citation

Tuohy, Carolyn Hughes, Paths of Progress in Healthcare Reform: The Scale and Pace of Change in Four Advanced Nations (August 28, 2010). APSA 2010 Annual Meeting Paper, Available at SSRN: https://ssrn.com/abstract=1642790

Carolyn Hughes Tuohy (Contact Author)

University of Toronto - Department of Political Science ( email )

Sidney Smith Hall
100 St George Street
Toronto, Ontario M5S 3G3
Canada
416-978-2181 (Phone)
416-488-4071 (Fax)

Do you have a job opening that you would like to promote on SSRN?

Paper statistics

Downloads
193
Abstract Views
697
rank
187,726
PlumX Metrics