Carolyn Hughes Tuohy

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The impact of private finance on publicly funded health care systems depends on how the relationship between public and private finance is structured. This essay first reviews the experience in five nations that exemplify different ways of drawing the public/private boundary to address the particular questions raised by each model. This review is then used(More)
This article examines the cases of three health care states -- two of which (Britain and the Netherlands) have undergone major policy reform and one of which (Canada) has experienced only marginal adjustments. The British and Dutch reforms have variously altered the balance of power, the mix of instruments of control, and the organizing principles. As a(More)
Different patterns of change in the American, British, and Canadian health care systems in the 1990s result from the particular logic of each system. Different balances of influence across major categories of actors, and different mixes of hierarchical, market-based, and collegial instruments have different implications for lines of accountability and for(More)
In political discourse, the term "single-payer system" originated in an attempt to stake out a middle ground between the public and private sectors in providing universal access to health care. In this view, a single-payer system is one in which health care is financed by government and delivered by privately owned and operated health care providers. The(More)
Current ideas about the role of the state include an enthusiasm for mechanisms of "indirect" or "third-party" governance. The health care arena, in which models of indirect governance have a long history, is an important test bed for these ideas. Classically, the arena was marked by trust-based, principal-agent relationships established to overcome(More)
The regulation of medical practice can historically be understood as a second-level agency relationship whereby the state delegated authority to professional bodies to police the primary agency relationship between the individual physician and the patient. Borow, Levi and Glekin show how different national systems vary in the degree to which they insist on(More)
The sharp decline and equally sharp recovery in public health care spending in the 1990s in Canada set the stage for a broad consideration of reform options but also established hurdles to be overcome in taking action. By moving health care to the center of the federal-provincial agenda, reconfiguring the internal politics of medical and hospital groups,(More)