While it is commonly accepted that the broader political and economic climate directly influences the nature of any major changes in the provision of health care (witness the 1991 National Health Service reforms in the United Kingdom), there is less consideration of the effect of paradigm changes in health care and health care management themselves on wider political and ideological strategies. This article examines the recent health policy initiatives presented by Britain's Labour Party. The author argues that while the Conservatives' market-oriented reforms reflected the perceived political and economic realities of the 1980s, the rapidly increasing credibility of strategies of prevention within the health care sector (including an emphasis on the social determinants of ill-health, the need to plan a shift from acute to community care, and the desire for greater lay participation in policy-making) allows Labour to highlight the limitations of a strongly market-oriented system in the health care sector more so than in any other policy area.
Get full access to this article
View all access options for this article.
References
1.
EvansR. G.BarerM. L.MarmorT. R. (eds.). Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. Aldine de Gruyter, New York, 1994.
2.
GlaserW. A.The competition vogue and its outcomes. Lancet341: 805–812, 1993.
3.
MarmorT. R.MaynardA.Cross-national Transfer of Health Policy Ideas: The Case of ‘Managed Competition.’ Paper presented at the International Political Science Association General Meeting, Berlin, August 1994.
4.
U.S. Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives. U.S. Government Printing Office, Washington, D.C., 1990.
5.
United Kingdom, Department of Health. The Health of the Nation. HMSO, London, 1992.
6.
Canada, Department of National Health and Welfare. A New Perspective of the Health of Canadians. Supply and Service, Ottawa, 1974.
7.
StoeckleJ. D.The citadel cannot hold: Technologies go outside the hospital, patients and doctors too. Milbank Q. 73: 3–17, 1995.
8.
PicardA.‘One-stop shopping’ is Quebec's answer. Globe and Mail, April 28, 1992, p. A7.
9.
BlackD.Inequalities in Health: The Black Report. Penguin, Middlesex, 1982.
10.
BrownE. R.Community action for health promotion: A strategy to empower individuals and communities. Int. J. Health Serv. 21: 441–456, 1991.
11.
FarrantW.Addressing the contradictions: Health promotion and community health action in the United Kingdom. Int. J. Health Serv. 21: 423–439, 1991.
12.
GraceV. M.The marketing of empowerment and the construction of the health consumer: A critique of health promotion. Int. J. Health Serv. 21: 329–343, 1991.
13.
LuptonD.Risk as moral danger: The social and political functions of risk discourse in public health. Int. J. Health Serv. 23: 425–435, 1993.
14.
SaltmanR. B.Patient choice and patient empowerment in northern European health systems: A conceptual framework. Int. J. Health Serv. 24: 201–229, 1994.
15.
O'NeillM.Community participation in Quebec's health system: A strategy to curtail community empowerment?Int. J. Health Serv. 22: 287–301, 1992.
16.
MhatreS. L.DeberR. B.From equal access to health care to equitable access to health: A review of Canadian provincial health commissions and reports. Int. J. Health Serv. 22: 645–668, 1992.
17.
PurchaseB.HirshhornR.Searching for Good Governance. School of Policy Studies, Queen's University, Kingston, Ont., Canada, 1994.
18.
MitchellA.Leaving bad news to the managers. Globe and Mail, October 11, 1994, p. A4.
BlunkettD.Patients is a virtue. New Statesman and Society, November 26, 1993, p. 22.
21.
Public concern focuses on health service. The Times, March 4, 1994, p. 9.
22.
MilneK.Labour's healthy sums. New Statesman and Society, April 14, 1995, pp. 18–20.
23.
ThomsonA.Beckett condemns ‘profit from sickness and disease.’The Times, February 1, 1995, p. 8.
24.
GlennersterH.GP fundholding: Wild card or winning hand? In Evaluating the NHS Reforms, edited by RobinsonR.Le GrandJ., pp. 74–107. King's Fund Institute, London, 1993.
25.
LauranceJ.Fundholding GPs share £1m intended for hospital care. The Times, January 18, 1994, p. 9.
26.
NHS Audit Commission. Briefing on GP Fundholding. HMSO, London, July 1995.
27.
NHS ‘whittled away.’The Times, January 10, 1994, p. 2.
28.
LauranceJ.NHS beds in London ‘being cut too far, too fast.’The Times, February 22, 1995, p. 7.
29.
BlunkettD.Going Private: The Growth of Private Sector Health Care Under the Tories. Labour Party, London, September 1994.
30.
Labour Party. Health 2000: The Health and Wealth of the Nation in the 21st Century. London, 1994.
31.
NHS Audit Commission. The Doctors' Tale: The Work of Hospital Doctors in England and Wales. HMSO, London, 1995.
32.
Labour Party. Renewing the NHS: Labour's Agenda for a Healthier Britain. London, 1995. [Reprinted in Int. J. Health Serv. 26(2): 269–308, 1996.]
33.
LauranceJ.Spending on NHS red tape ‘soars.’The Times, January 13, 1994, p. 2.
34.
NHS Audit Commission. A Price on Their Heads: Measuring Management Costs. HMSO, London, May 1995.
35.
NHS trust chiefs paid £100,000. The Times, January 2, 1995, p. 6.
36.
LauranceJ.NHS trust chiefs are awarded pay rises of up to 27%. The Times, January 4, 1995, p. 2.
37.
WilliamsonN.Selection for NHS trust jobs criticised. The Times, February 9, 1995, p. 9.
38.
WilliamsonN.Bottomley promises fairness on trust jobs. The Times, February 15, 1995, p. 6.
39.
ThomsonA.Beckett accuses Tories of loading health trusts. The Times, October 26, 1994, p. 26.
40.
NHS Management Executive. Local Voices: The View of Local People in Purchasing for Health. London, 1992.
41.
PrimaroloD.Labour policy: Going forward from the Black report. Health Visitor54: 13, 1993.
