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About this book

A broad-ranging introduction to the provision, funding and governance of health care across a variety of health systems. The fully revised fourth edition incorporates additional material on global health issues and expanded coverage of the role and functions of international organizations in relation to the provision and management of health care.

Table of Contents

Chapter 1. Comparative Health Policy: An Introduction

Abstract
Health care has always been a controversial policy area, but over the last decades it has become a major issue in all developed nations. Ageing populations, the proliferation of new medical technologies, and heightened public expectations and demands, among other factors, have elevated health care to the top of the political agenda. Intensifying pressures on political leaders to meet rising public demands for expanded service conflict directly with the need to constrain health care costs and to manage scarce societal resources. Thus, despite major differences among countries as to how health care is funded, provided and governed, no government has been able to escape the controversy and problems accompanying health care in the 21st century, although some seem to be coping significantly better than others. Why is that so?
Robert H. Blank, Viola Burau

Chapter 2. The Context of Health Care

Abstract
The health policy of any country at a particular point in time is the product of a multitude of factors, the most important of which are displayed in Figure 2.1. These factors include the intrinsic social, cultural and political fabric of a country, including its social values and structures, political institutions and traditions, the legal system and the characteristics of its health care community. For instance, policy-making authority might be highly centralized or widely dispersed across multiple levels. Moreover, in some countries unions and/or corporate structures are strong factors in determining social policy and might, in effect, have a veto power over proposed policy changes made by the government. Likewise, the influence of the medical industry and medical associations varies widely, as does the power of insurance providers in shaping health policy.
Robert H. Blank, Viola Burau

Chapter 3. Funding, Provision and Governance

Abstract
Health care is often thought of as a system. A health system is a highly complex entity and consists of a range of sub-systems. Among these, the sub-systems of funding, provision and governance are central for understanding health policy comparatively.
Robert H. Blank, Viola Burau

Chapter 4. Setting Priorities and Allocating Resources

Abstract
Chapter 3 demonstrated that health systems display variation in the subsystems of funding, provision and governance that impact on health policy and health care. It also revealed that these sub-systems are dynamic and that many of them have undergone significant changes in recent decades. In order to better understand their impact on health care, it is important to go beneath the institutional and structural dimensions and examine the goals, objectives and priorities of each health system. This chapter also examines the criteria that health care systems use to allocate medical resources and the ramifications of these policies for their respective populations.
Robert H. Blank, Viola Burau

Chapter 5. The Medical Profession

Abstract
The power of the medical profession stems from the fact that health care is largely defined as medical care. Doctors are responsible for diagnosis and as such define patients’ health care needs. Doctors also provide treatment, but more often than not this involves (either directly or by referral) other health practitioners, such as medical specialists, nurses, physiotherapists, laboratory technicians or dieticians (see Box 5.1). This puts doctors in a key position regarding the allocation of health care resources. Health systems, health policy and politics cannot be understood without doctors and vice versa. Doctors often enjoy considerable power and are seen as the archetypal example of a profession. Autonomy and dominance are at the heart of medical power and refer to the ability of doctors to make autonomous decisions concerning the contents and the conditions of medical work (see also Box 5.2).
Robert H. Blank, Viola Burau

Chapter 6. Beyond the Hospital: Health Care in the Home

Abstract
Care outside hospitals has traditionally been the poor relation of health systems. Health systems are concerned first and foremost with the provision of medical care and focus on acute illness. Doctors are the key professionals shaping the delivery of health care and hospitals are the primary location. The emphasis is on curing as opposed long-term caring. Less acute, more long-term health care is typically characterized by considerable diversity in terms of the range of services, the user groups, the localities of service provision and the professionals involved.
Robert H. Blank, Viola Burau

Chapter 7. Public Health

Abstract
Until now the focus of this book has been on health care policy. We have been concerned with hospitals, doctors and other health care professionals and the funding, delivery and governance of health care services. Largely, it has centred on the care of individual patients. Chapter 5 demonstrated the wide range of settings and activities in the delivery of modern medical care. Chapter 6 extended this to integrate health care with non-health arenas by demonstrating that it is not possible to disengage health care from social care. The health of a home care client is as dependent on personal care as it is on medical care, perhaps in many cases more so. Even this more inclusive picture of health care, however, might be criticized for underestimating what are its most important dimensions according to some observers: health promotion and disease prevention, which together are regularly termed public health. Due to the breadth and rather amorphous nature of public health, this chapter is more of an overview of the policy concerns facing our countries than a comparative analysis as were previous chapters. Examples from our countries, nevertheless, are used throughout the discussion to demonstrate the wide scope of public health issues facing all countries.
Robert H. Blank, Viola Burau

Chapter 8. Understanding Health Policy Comparatively

Abstract
In analysing health policy in a comparative context, the preceding chapters have covered a wide range of topics including the historical and cultural trajectories of health policy; systems of funding, providing and governing health care; policies of allocating health resources; health care in the home; and the diverse policies that constitute public health. As in any cross-country comparison, a tension emerges between similarities and difference, between common policy trends, such as the ubiquity of rationing, and policy divergence, such as welfare mix in the provision of hospital services. Similarly, in their study of 11 high income countries, Tenbensal et al. (2012: 29) found significant ‘islands of difference’ in an overall ‘sea of similarity’ among the health policy agendas of the selected countries.
Robert H. Blank, Viola Burau
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