Document Type

Article

Language

eng

Publication Date

7-1995

Publisher

Wiley

Source Publication

Governance: An International Journal of Policy, Administration and Institutions

Source ISSN

0952-1895

Abstract

Health care systems in the postwar period have been governed by political bargains between the state and the medical profession that have delineated their respective powers and jurisdictions. Recent health care cost containment reforms in Britain and Germany are altering these bargains, and thereby challenge the prerogatives and autonomy of the medical profession in health policy formulation and in administration of the health care systems. But these challenges to doctors' power and autonomy vary between the two countries. Britain's 1989 “internal market” reforms attack the corporatist bargain with physicians by introducing market mechanisms into the National Health Service and, at the same time, strengthening central state control of the health care system. In Germany, on the other hand, the government's 1992 reforms only partially breached the corporatist bargain with doctors in order to strengthen rather than destroy this governance arrangement. The government has tried to curb what it views as excessive power of doctors while still allowing them a significant degree of corporatist self-governance. The reform efforts in both countries highlight some of the problems with different governance arrangements in health care systems and, more specifically, the difficulties associated with a market in health care.

Comments

Published version. Governance: An International Journal of Policy, Administration and Institutions, Vol. 8, No. 3 (July 1995): 354-379. DOI. © 1999 SAGE Publications. Used with permission.

Susan Giaimo was affiliated with University of California - Berkeley at the time of publication.

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