Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada / Edition 1

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What drives change in health care systems? Why do certain changes occu r in some nations and not in others? Author Carolyn Hughes Tuohy argue s that the answer lies in understanding the "accidents" of history tha t have shaped national systems at critical moments, and in the distinc tive "logics" of these systems. Tuohy looks at the experiences of Brit ain, Canada, and the US, offering an international comparative study o f public policy systems, as well as a recent history of the circumstan ces in each country that have impacted on the structures of each's nat ional health care system. The guiding focus of the book is Tuohy's stu dy of decision making systems in each country, looking at the decision s made by those who provide, finance, and use health care services. Fi nally, Tuohy reviews current issues in the health care arenas of these three nations and provides suggestions to guide the strategic judgmen ts that decision-makers must make.

"...offers an international comparative study of public policy systems as well as a recent history of the circumstances in each country that have made an impact on the structures of these national health-care systems."

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Editorial Reviews

From the Publisher
"Combining a mastery of empirical data and of theory, Professor Tuohy has produced the most sophisticated and illuminating account yet of how and why nations differ in their health policies. An indispensable read for health policy specialists, it is also an invaluable addition to the comparativist literature."—Rudolf Klein, Senior Associate, King's Fund, London

"Carolyn Tuohy's new book is splendid, the most significant scholarly work in comparative health politics and policy in the last two decades. Aiming to understand both change and continuity in American, Canadian, and British medical policy in the half-century after W.W.II, Tuohy manages both to do that and to make a theoretical contribution to the political analysis of public policy. No other recent work is of comparable scope and skill—a book, in short, worth reading by anyone seriously interested in politics, economics, and sociology of modern medical care."—Theodore R. Marmor, Professor of Public Policy & Management, Yale University

"Accidental Logics is a terrific book. Carolyn Tuohy makes the extraordinarily complex world of health care reform understandable even to non-experts, showing how past policy choices have caused three countries to address health care cost pressures in strikingly different ways. It is must reading for serious students of the welfare state."—Kent Weaver, Senior Fellow in Governmental Studies, The Brookings Institution

"An intellectually exciting book. An important theoretical contribution on path dependency in public policy, and a compelling reminder that different countries can and do chart distinctive approaches to heath care even in a global era."—Keith Banting, School of Policy Studies, Queen's University, Ontario

"The impressive book gives a detailed account of how different countries have responded to new but similar problems in the area of health care. It emphasizes the persistence of national traditions and the impact of decisions taken decades ago on current change, thus providing a clear and convincing application of the path dependency thesis. But it goes further than this by specifying the conditions that permit structural change in health care policy. In this respect, it marks a major step forward in our understanding of how health policy, and public policies in general, are made."—Ian Gough, Department of Social and Policy Sciences, University of Bath

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Product Details

  • ISBN-13: 9780195128215
  • Publisher: Oxford University Press, USA
  • Publication date: 4/28/1999
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 328
  • Lexile: 1560L (what's this?)
  • Product dimensions: 9.10 (w) x 6.30 (h) x 1.20 (d)

Meet the Author

University of Toronto
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Table of Contents

Ch. 1. Understanding the Dynamics of Change in the Health Care Arena
Part I: Episodes of Policy Change
Ch. 2. The Establishment of the Welfare State in the Health Care Arena
Ch. 3. The Reforms of the 1990s
Ch. 4. Ideas, Institutions, Interests, and Actors and the Accidents of Policy Episodes
Part II: The Distinctive Logics of National Systems
Ch. 5. The US: The Logic of the Mixed Market
Ch. 6. Britain: The Logic of Corporatism Meets the Internal Market
Ch. 7. Canada: The Logic of the Single-Payer System
Ch. 8. Conclusion

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