Explaining Change in the National Health Service: Corporatism, Closure and Democratic Capitalism
| Date | 01 June 1995 |
| DOI | 10.1177/095207679501000203 |
| Author | Michael Moran |
| Published date | 01 June 1995 |
| Subject Matter | Articles |
21
Explaining
Change
in
the
National
Health
Service:
Corporatism,
Closure
and
Democratic
Capitalism
Michael
Moran
University
of Manchester
Abstract
The
National
Health
Service
was
a
political
settlement
based
on
meso-
corporatism.
That
settlement
was
destabilised
by
economic
competition
in
markets
and
political
competition
in
democratic
arenas.
The
reforms
of
recent
years
are
an
attempt
to
create
a
new
authority
structure
capable
of
legitimising
the
rationing
decisions
made
in
the
delivery
of
health
care.
That
attempt
is
failing.
The
questions
Why
have
the
British
health
care
reforms
been
so
radical,
and
why
have
they
so
often
been
carried
out
in
an
adversarial
way?
These
questions
are
prompted
by
a
comparison
of
Britain
with
experience
abroad.
Only
two
significant
examples
can
match
the
British:
in
eastern
Europe
there
has
been
a
radical
privatisation
of
much
of
the
old
socialist
health
care
system,
while
in
the
capitalist
world
New
Zealand
has
attempted
severely
to
restrict
its
generous
entitlements
in
health
care
(on
the
latter
see
Fougere,
1994).
It
is
plain,
however,
that
these
radical
examples
derive
from
highly
particular
circumstances:
from
the
collapse
of
the
old
system
of
command
communism;
and
from
the
intense
economic
pressures
placed
on
New
Zealand
by
the
closure
of
its
established
markets
in
the
European
Union.
When
we
attempt
a
more
obvious
comparison,
placing
Britain
alongside
the
capitalist
nations
of
Northern
Europe,
the
peculiarities
of
the
British
are
highlighted.
All
these
countries
are
treading
the
same
path
as
Britain,
but
are
doing
so
in
a
much
more
cautious
way.
In
Germany
the
Seehofer
Gesund-
heitsstruktur-Gesetz
of
December
1992,
though
radical
by
German
standards,
came
at
the
end
of
a
history
of
piecemeal
reform
stretching
back
to
the
Cost
Containment
Act
of
1977
(Moran,
1994).
In
Holland,
the
reforms
succeeding
the
publication
of
the
Dekker
Report
evolved
through
a
long
process
of
consensus
building
between
the
main
organised
interests.
In
Scandinavia,
whose
health
care
systems
resemble
ours,
reforms
have
been
piecemeal,
have
(notably
in
Sweden)
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