Health system reforms toward a framework for international comparisons

Social Science and Medicine

Volumn 43, Issue 5, 1996, Pages 637-654

  Twaddle, Andrew C ^a  

^a UNIVERSITY OF MISSOURI   (United States)

Author keywords

Health care reform; Health system reforms

Indexed keywords

ALIENATION; CONFERENCE PAPER; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HUMAN; MARKET; MODEL;

HEALTH CARE REFORM; INTERNATIONAL COMPARISON; METHODOLOGICAL APPROACH;

EID: 0030222709     PISSN: 02779536     EISSN: None     Source Type: Journal    
DOI: 10.1016/0277-9536(96)00151-7     Document Type: Conference Paper

References (106)

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26. 26. Space limitation prohibits more than the barest outline of these issues here. A fuller statement has been drafted by the author as a working paper for another project.
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31. 29. There is reason to doubt that assertion. If one compares the administrative overhead of the U.S. national program of health insurance for the aged (Medicare) with that of private insurance companies, for example, the public system appears to be much more efficient. A recent report from the Federation of County Councils in Sweden showed that three traditional counties with publically planned medical care which were most successful in cost cutting outperformed the three counties using market reforms that cut their costs the most: [29A].
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34. 31. Indeed, in the past decade, some of the Scandinavian countries have actually succeeded in reducing the percentage of GDP spent on medical care.
35. 32. The evidence is not yet complete as to whether there is a crisis that would satisfy Wallerstein's definition,.... the circumstance in which an historical system has evolved to the point where the cumulative effect of its internal contradictions make it impossible for the system to resolve its dilemmas by adjustments in its ongoing institutional patterns [33]. The term, however, is widely used and we adopt it in its more popular sense.
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54. 49. In this type, I have been much influenced by discussions with Thomas Brante.
55. 50. In different ways, each of the ideal types has already been discussed with reference to medical care organization. In the discussion of medical care, for example, Talcott Parsons [51, cf. 52-54] argued that the market was unsuitable for medical care organization. Given the importance of medicine for individuals and the vulnerability of the sick to exploitation, only a professional mode of organization that makes the patient's needs central would be appropriate. Other observers have discussed medicine as a market activity, with special emphasis on its putative superiority to communal modes of organization in providing a more efficient and cost-effective service [2-4, 6-9, 15, 17, 21]. Several observers have framed discussion of medical care changes in terms of a conflict between professional and market modes of organization, seeing the growing strengths of market modes of organization as a threat to professional modes [19, 20, 36, 55, 56].
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98. 93. Particularly good summaries can be found in [14, 74].
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100. 95. Wallerstein would presumably contend that medicine, based on scientific principles, is an aspect of world capitalism in this regard. See his essay, Typology of Crises in the World System in Ref. [33], pp. 104-22.
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105. 100. Jessop differentiates economic hegemony from economic domination and economic determination. The former occurs when one one fraction is able to impose its own particular economic-corporate interests on the other fractions regardless of their wishes and/or at their expense (p. 199). It is an exercise in power. The latter is not formally defined in Jessop's book. Economic hegemony, by contrast, derives from economic leadership won through general acceptance of an accumulation regime (p. 199).
106. 101. While one could argue that the accumulation regime supported by the US examples is the same, there are important differences in the degree to which Carter and Clinton, on the one hand, and Reagan and Gingrich on the other proposed to shift the costs of the project to the underclasses of the society. One could, of course, elaborate the examples to include the Swedish Social Democrats since 1982 and the more rapacious Bildt government of 1991-94 among others.