All advanced health care systems face severe difficulties in financing the delivery of today’s sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables—the autonomy of the state and the strength and cohesiveness of organized medicine—explain this variance.
In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult.
Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession’s clinical autonomy and physicians’ incomes.
- Contents
- List of Tables
- List of Figures
- Acknowledgments
- Chapter 1. Introduction: Comparing Organized Medicine and Health Policies in France and the United States
- Chapter 2. Unity and Fragmentation of the French State
- Chapter 3. The Fragmentation of the Stateless State: The Effects of Absolute Liberalism on Politics in the United States
- Chapter 4. Cohesion and Fragmentation of Organized Medicine in France and the United States
- Chapter 5. The Continuity of Crisis: Patterns of Making Health Policy in France, 1978-1990
- Chapter 6. Policy Issues in France: State Reforms and Medical Resistance
- Chapter 7. Public and Private Forces in the American Health Universe
- Chapter 8. Patterns of Making Health Policy in France and the United States
- Chapter 9. Consequences for the Political Activites of Organized Medicine
- Chapter 10. Conclusion
- Appendix A: Glossary of Abbreviations
- Appendix B: Medical Unions and Associations in the French Hospital Sector
- Notes
- References
- Index
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