CONTENTS: Acknowledgements ix Introduction 1 The Structure 2 Using this Book 4 Part One : Theory and Context 5 1. Studying Health Policy 7 Introduction 7 What is a 'Policy' ? 7 Defining the Characteristics of Public Policy 8 Scoping the Field of Health Policy Analysis 9 Conceptual Frameworks in the Analysis of Health Policy 12 'Power' as a Key Concept for Critical Health Policy Analysis 14 Activity 1 - Commentary 16 Summary 17 Further Reading 17 2. The Role of the State: Theory and Practice 18 Introduction 18 Theorising the Modern State 19 A Case Study: Adopting a Path-dependency Approach in Comparing British Health Policy in the 1950s with that of the 1980s 27 Conceptualising the Role of the Welfare State in Healthcare Provision 29 Conclusions 35 Summary 36 Further Reading 37 3. The Policy-Making Process 38 Introduction 38 Decision-Making in Bureaucratic Organisations 39 Ideal-type Models of Public Policy Decision-making 42 Who Sets the Policy Agenda? 45 The Implementation of Policy 47 A Case Study of Policy Implementation: Developing a Patient-Centred Approach in General Practice 50 Summary 52 Further Reading 52 Part Two : The Healthcare System 55 4. The Structure of Healthcare in the UK: Continuity and Change 57 Introduction 57 The Historical Background to the Development of the NHS 58 The National Health Service 1948-1989 60 Reforming the Structure of the NHS: 1990 and Beyond 64 The NHS in Scotland, Wales and Northern Ireland 69 Summary 71 Further Reading 72 5. The System of Healthcare Funding in the UK 73 Introduction 73 Funding the Post-war NHS 74 The Financial Impact of the Purchaser-Provider Split in the NHS 77 The Role of Private Finance in the NHS 80 Summary 83 Further Reading 83 6. A Comparative Analysis of European Healthcare Systems: Changing Demands, Common Solutions? 84 Introduction 84 An Introduction to Comparative Health And Social Policy Analysis 85 State Intervention in Healthcare: The formation of European Healthcare Systems 87 The Changing Demands Upon European Healthcare Systems 92 Comparing European Healthcare Systems Across Three Dimensions: Finance, Provision and Regulation 96 Is There a Process of Convergence Occuring within European Healthcare Systems? 104 Summary 105 Further Reading 106 Part Three: Issues in Healthcare Provision 107 7. Governing the Medical Profession 109 Introduction 109 National Health Service or National Medical Service?: The Hegemony of the Medical Profession 110 The Dominance and Autonomy of the Medical Profession 112 New Challenges to the Dominance of the Medical Profession 115 Summary 122 Further Reading 122 8. Managing the Performance of the NHS 124 Background: System Reform and Organisational Performance 124 Constructing a Performance Assessment and Management Framework in the NHS 127 The Developing Role of Regulatory Agencies with in the Modernised NHS : The Work of NICE and the Healthcare Commission 131 A Case Study of the Work of NICE - Beta Interferon as a Treatment for Multiple Sclerosis 132 Organisational Culture and the Measurement of Performance with in the NHS 136 Decentralising Decision-Making: An Organisational Model for the NHS? 139 Summary 141 Further Reading 141 9. A Patient-Led Health Service? Choice, Equity and the Supplier Market 143 Background: A Framework for Healthcare Reform 143 Commissioning and the Expanding Role of the 'Supplier' Market 146 'Empowering' the Service-User?: The 'Choice Agenda' and the 'Demand-side' Reforms with in the NHS 151 Issues of Equity in Access and Treatment 155 Summary 157 Further Reading 158 10. Meeting Long-term Health and Social Care Needs in the Community 159 Introduction 159 Background: The Health and Social Care Divide 160 The Development of a 'Community Care' Policy 162 The Organisation of Health and Social Care Under the New Labour Government 166 The Role of 'Informal Carers' in Health and Social Care Policy 168 Meeting the Needs of Carers: Practicalities and Policy 170 The State of Social Care: The Need for Further Reform? 172 Summary 178 Further Reading 178 Part Four : Looking to the Future 179 11. Health Beyond Policy 181 Introduction 181 The Limitations of Public Health Policy: Health, Behaviour and Lifestyle 184 Case Study - The Campaign to Reduce Levels of Teenage Pregnancy in the UK 186 The Failure of Health Policy: Addressing Social Inequalities in Health 187 What Policy? : Health and Global Risk 195 Further Reading 197 Notes 198 References 199 Index 213