Rethinking the Welfare State: The prospects for ... - e-Library

Notes 240
42 Giaimo and Manow, supra note 32.
43 Day and Klein, supra note 37, p. 288.
44 Note that the distinction between Directly Managed Units (DMUs) and NHS Trusts has
become irrelevant as by 1997 all hospitals and community units had applied for and become
trusts, shedding their DMU status. J.Appleby, “The reforms of the British national service,”
in F.Powell and A.Wesson (eds) Health Care Systems in Transition: An International
Perspective (Thousand Oaks, GA: Sage Publications, 1999), pp. 305, 310.
45 Giaimo and Manow, supra note 32.
46 Flood, supra note 22, p. 98.
47 Giaimo and Manow, supra note 32, p. 178.
48 Flood, supra note 22, p. 98.
49 C.H.Tuohy, Accidental Logics: The Dynamics of Change in the Health Care Arena in the
United States, Britain, and Canada (Oxford and New York: Oxford University Press, 1999),
p. 169.
50 Ibid., p. 171.
51 Ibid.
52 Ibid., p. 170.
53 Day and Klein, supra note 37, p. 288.
54 C.Paton, “The politics and economics of health care reform: Britain in comparative context,”
in C.Altenstetter and J.W.Bjorkman (eds) Health Policy Reform, National Variations and
Globalization (New York: St Martin’s Press, 1997), pp. 175, 177.
55 Ibid.
56 Flood, supra note 22, p. 101.
57 Carolyn Hughes Tuohy, “Agency, contract and governance: shifting shapes of accountability
in the health care arena,” Journal of Health Politics, Policy and Law, 28 (2003), p. 207.
58 R.Klein and J.Dixon, “Cash bonanza for NHS: the price is centralization,” British Medical
Journal, 320 (2000), pp. 889–90.
59 Alain C.Enthoven—the principal proponent of managed competition in America—
summarises the development of this view in “The history and principles of managed
competition,” Health Affairs, 12 (1993, Supp.), p. 24.
60 In the spring of 1993, more than 40 million Americans (15 percent of the population) lacked
health insurance. Although the uninsured are provided with some basic health care services,
these services are substantially more limited than those provided to individuals who are
covered—routine care is generally forgone, and more serious illnesses tend to be dealt with
later in their course when doctors can do less to treat them. See Glied, supra note 9, p. 5.
61 Ibid., p. 8.
62 Flood, supra note 22, p. 50.
63 The Alliances would negotiate on behalf of everyone except those on Medicare and
employees in firms with over 5,000 employees.
64 Flood, supra note 22, p. 52.
65 Ibid.
66 See Colleen Flood, supra note 14, Chapter 8. The American system, as it exists now, is
allocatively inefficient. Although overall life expectancy is not exceptionally high in the
United States, the life expectancy for those over eighty is the highest in the world. That is, a
disproportionate amount of resources are spent on prolonging the end of life, and much less
are going toward preventive and primary services. See G.J.Scheiber et al., “Health system
performance in OECD countries, 1980–1992,” Health Affairs, 13(4) (Fall, 1994), pp. 100,
106, Exhibit 4, from OECD data and their own estimates.
67 R.Klein and J.Dixon, “Cash bonanza for NHS: the price is centralization,” British Medical
Journal, 320 (2000), pp. 889–90.
68 Paul Belien, “Patient empowerment in Europe,” Fraser Forum (Vancouver: Fraser Institute,
February, 1998).