Keywords: academic physicians, Canada, Health Resource Centre / Group, market principles, medical administrative elite / knowledge elite / rank and file, Medical Care Act / The Canada Health Act, medical sociology, Medicare Plan, private for-profit / public not-for-profit healthcare, public health policy / management,
Abstract: The extent to which health systems rely on for-profit mechanisms to deliver public health services varies and can be a source of tension for managers as well as politicians. Canada is generally understood to have a not-for-profit public health system that is frequently contrasted with that of the US, heavily reliant on market principles and price mechanisms. This article examines Canada’s public health system from the perspective of a single province—Alberta. In particular, this article examines Alberta’s various attempts to introduce private for-profit services into a seemingly public not-for-profit health system. It focuses on a case study of the demise of a private for-profit surgical facility and examines factors associated with its failure. Physicians are key actors in health systems. This article challenges assumptions held about physicians as policy actors and suggests that policy analysts and policy makers need to do a better job understanding the centrality of physicians for health policy outcomes.
Keywords: Department of Health (DH), England, healthcare competition / cost effectiveness / innovation / management / objectives / roles and responsibilities / quality, market principles, National Health Service (NHS), organisational complexity / logic, patient choice, ‘permanently failing organisations’, private / publicly funded healthcare, The Health and Social Care Act 2012,
Abstract: This article outlines the radical management changes introduced by The Health and Social Care Act 2012 (HSCA) in the English National Health Service (NHS) in 2013 and discusses their possible effects on NHS as an organisation. This article argues that the HSCA reforms—designed to enhance market principles—represent a political solution to management problems, driven by financial and ideological priorities. Because of conflicting objectives, unclear distribution of authority, organisational complexity, and lack of sensitivity to the NHS’ historical culture and structure, the outcome may be a ‘permanently failing organisation’.