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Why hasn't integrated health care developed widely in the United States and not at all in England?

Bevan, Gwyn and Janus, Katharina (2011) Why hasn't integrated health care developed widely in the United States and not at all in England? Journal of Health Politics, Policy and Law, 36 (1). pp. 141-164. ISSN 0361-6878

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Abstract

There have been influential advocates for financing and organizing health care in the United States and England based on the model of integrated health care delivery systems (IHCDSs). Despite good evidence that a few IHCDSs provide high-quality health care economically, such organizations are rare and localized in a few market areas in the United States and are absent in the English National Health Service (NHS). The explanation of why this is so includes various contributory factors: the way the development of the medical profession in each country pursued specialization; the division in British medicine between general practitioners and specialists; and the characteristics that we identify of established successful IHCDSs, which created formidable barriers to entry for a new IHCDS. This explains why currently the most promising organizational developments in U.S. health care are hybrids resulting from vertical integration. In England government policies of an "internal market," as adopted in the 1990s and currently, were and are based on a purchaser-provider split with the objectives that providers would compete and be funded by a system in which "money follows the patient." These policies recognize the division in British medicine, which also means that it is difficult to implement a reorganized English NHS based on high-performing IHCDSs.

Item Type: Article
Official URL: http://jhppl.dukejournals.org/
Additional Information: © 2011 Duke University Press
Library of Congress subject classification: J Political Science > JC Political theory
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets: Departments > Management
Research centres and groups > Centre for Analysis of Risk and Regulation (CARR)
Research centres and groups > LSE Health
Rights: http://www.lse.ac.uk/library/usingTheLibrary/academicSupport/OA/depositYourResearch.aspx
Date Deposited: 26 May 2011 14:31
URL: http://eprints.lse.ac.uk/36029/

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