Markets and Medicine : The Politics of Health Care Reform in Britain, Germany, and the United States

Markets and Medicine : The Politics of Health Care Reform in Britain, Germany, and the United States



Are advanced industrialized countries converging on a market response to reform their systems of social protection? By comparing the health care reform experiences of Britain, Germany, and the United States in the 1990s, Susan Giaimo finds that countries have pursued diverse policy responses and that such variations reflect distinctive institutions, actors, and reform politics in each country.

In Britain, the Thatcher government's plan to inject a market into the state-administered national health service resulted in a circumscribed experiment orchestrated from above. In Germany, the Kohl government sought to repair defects in the corporatist arrangement with doctors and insurers, thus limiting the market experiment and designing it to safeguard and even enhance the solidarity of the national health insurance system. In the United States, private market actors foiled President Clinton's bid to expand the federal government's role in the private health care system through managed competition and national insurance. But market reform continued, albeit led by private employers and with government officials playing a reactive role. Actors and institutions surrounding the existing health care settlement in each country created particular reform politics that either militated against or fostered the deployment of competition.

Nevertheless, major transformations in governance arrangements are occurring in private as well as public systems of social protection. This finding suggests that studies of change in social policy expand their focus beyond statutory welfare state reform in advanced industrial societies. This book will be of interest to social scientists concerned with the changing balance among state, market, and societal interests in governance, as well as to health policy researchers, health policymakers, and health care professionals.



Publication Date



University of Michigan Press


Ann Arbor


Political Science


Table of Contents

Introduction: Cost Containment and the Governance of Health Care

Health Care Governance in the British NHS to 1989: A Hybrid of Corporatism and State Hierarchy

The British Reforms: Markets, Managers and the Challenge to Corporatism

The Corporatist Settlement in German National Health Insurance

The German Reforms: Grafting the Market onto Corporatism

The Autonomy of the Solo Practitioner in a Liberal Health Care System: The United States

Market Reform as “Unmanaged Competition”: The United States

Conclusion: The Limits of Market on Health Care

Appendix: Information on Interviews and Methodology




Markets and Medicine : The Politics of Health Care Reform in Britain, Germany, and the United States