Implementing Change in Health Systems brings fresh thinking and evidence to the continuing debate about market reforms of health care and other public services. The book examines the development and implementation of national cost-containment programs and health system reorganizations in the UK, Sweden and the Netherlands - countries that have been leaders in health system reform.

The book provides a new framework for analysing public policy implementation and system change, synthesizing diverse streams of academic research and thinking. It explores the processes of implementing market reforms in each country and considers the outcomes, both expected and unintended. In all three countries competitive reform encountered serious technical, organizational and political obstacles. Yet they triggered important system changes and paved the way for significant new health policies.

The complex outcomes of the reforms included

ochanges in the quality, efficiency and costs of care

ogrowing managerial and political control over physicians and other health care professionals

oincreased influence and centrality of community-based care

oDiffusion of ideas and practices from business management into health care.

Implementing Change in Health Systems sheds new light on crucial policy issues that are currently being debated throughout Europe and North America. The book will be of value to postgraduates, researchers, and practitioners in health policy and public policy.

MICHAEL I. HARRISON is an internationally-known scholar of health systems and organizations. He is a Senior Research Scientist at the Agency for Healthcare Research and Quality in Rockville, MD and Associate Professor of Sociology at Bar-Ilan University in Ramat Gan, Israel. He has taught at the State University of New York at Stony Brook and the School of Management at Boston College and has been a Visiting Scholar at Brandeis University, Georgetown University, Harvard Business School, and the Nordic School of Public Health.