Health and Society : Key Debates in Health Care

197 Pages·2010·3.311 MB·English

by  Gary Taylor

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Key Debates in
Health Care

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Key Debates in
Health Care
Gary Taylor and Helen Hawley

Open University Press
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OpenUniversityPress
McGraw-HillEducation
McGraw-HillHouse
ShoppenhangersRoad
Maidenhead
Berkshire
England
SL62QL
email:[email protected]
worldwideweb:www.openup.co.uk
andTwoPennPlaza,NewYork,NY10121-2289,USA
Firstpublished2010
Copyright(cid:2)C GaryTaylorandHelenHawley2010
Allrightsreserved.Exceptforthequotationofshortpassagesforthepurposesof
criticismandreview,nopartofthispublicationmaybereproduced,storedina
retrievalsystem,ortransmitted,inanyformorbyanymeans,electronic,
mechanical,photocopying,recordingorotherwise,withoutthepriorwritten
permissionofthepublisheroralicencefromtheCopyrightLicensingAgency
Limited.Detailsofsuchlicences(forreprographicreproduction)maybeobtained
fromtheCopyrightLicensingAgencyLtdofSaffronHouse,6–10KirbyStreet,
London,EC1N8TS.
AcataloguerecordofthisbookisavailablefromtheBritishLibrary
ISBN13:9780335223947(pb) 9780335223930(hb)
ISBN10:033522394X(pb) 0335223931(hb)

LibraryofCongressCataloging-in-PublicationData
CIPdatahasbeenappliedfor
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Contents
Acknowledgements vii
Introduction 1
1 Healthandhealthpolicy 7
PART1 THEPOLITICSOFPROVISION
2 Thestate 23
3 Theprivatesector 45
4 Thevoluntarysector 67
PART2 SETTINGPRIORITIES
5 Healthinequalities 85
6 Healthpromotion 103
7 Rationing 119
PART3 PATIENTSANDHEALTHPROFESSIONALS
8 Patients’rights 135
9 Professionalism 150
10 Conclusion 160
Bibliography 166
Index 187
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Acknowledgements
Without the support and encouragement from friends, colleagues and our
familiesthisbookwouldhavebeenimpossibletocomplete.Ourthanksgoin
particular to Mike McManus for showing us the way to make the politics of
healthaccessibleandrelevanttostudentstrainingtobehealthprofessionals.
AlisonMcCamleyhasbeensupportivethroughoutandwebenefitdailyfrom
herfriendship.WewouldalsoliketothankRachelCrookesatOpenUniversity
Pressforstayingwithusthroughouttheprocessofwritingthebookandfor
her sound advice, guidance and good humour. Our reviewers also made a
significant contribution to the final shape of this book and we thank them
for their comments. Some of the material contained in the book we have
previouslyhadpublishedasjournalarticles.Wewouldliketothanktheeditor
ofSocialPolicyJournalforpermissiontodrawuponmaterialfromTaylor,G.and
Hawley,H.(2004)‘Theconstructionofargumentsontherationingofhealth
care:perspectivesfromtheBritishbroadsheets’,SocialPolicyJournal,Volume3,
Number3,pp.45–62.MaterialfromTaylor,G.andHawley,H.(2006)‘Health
promotionandthefreedom oftheindividual’, HealthCare Analysis, Volume
14, Number 1, pp. 15–24 has been used with kind permission from Springer
ScienceandBusinessMedia.
Personal thanks and dedications

MythanksgotoKarenfordiscussingmanyoftheissues,commentingupon
thedraftchaptersandforkeepingourchildrenhappyandwell.Iwouldliketo
dedicatemyworkinthisbooktomyoldfamilyGPDrCranstonofKingshurst
Birmingham,whostayedupwithmenightafternightinthewinterof1963
andkeptmesafe.
GaryTaylor
My thanks go to Gavin for his support and understanding during my many
hours at the computer and also my parents for their constant faith in my
abilities.ThanksalsotothePublicHealthdepartmentofNHSRotherhamfor
givingmeagoodgroundingandfrontlineexperienceofaholisticapproach
tohealth.
HelenHawley
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Introduction
Chapter Contents
Keyquestions Thestructureofthechapters
Thestructureofthebook Conclusion
Thisbookisconcernedprimarilywithexploringkeydebatesontheroleofthe
stateinthedirectionandprovisionofhealthcareandhowthesedebatesare
reflected in the framing of health policy in a variety of countries. Although
its main focus is on the development of health policy in Britain and in the
UnitedStates,thebookalsotapsintoabroaderrangeofinternationalexam-
ples.Inapproachingthesedebates,wehaveattemptedtocapturetheflavour
ofatleastsomeoftheconflictandcontroversyoverhealthcareissues.Rather
thanconcentrateuponstatisticalmaterialontheneedsofthevariouspopu-
lationsortheextentofhealthcareprovisionindifferentcountries,wehave
chosentoviewthedebatesinapoliticalcontextinthebeliefthatrecording
conflictingviewsovertheaimsandprocessesofhealthcarewillhelpreadersto
locatethemselvesinpoliticaltermsandtothinktheirwaythroughalternative
approachestohealthcare.Whenwetalkaboutpolitics,however,wemeanit
in the broadest of senses. We are interested in capturing and illustrating the
importanceofdifferentworldviews.Althoughpoliticalpartiesandinfluential
politicians will sometimes express these views, they are fortunately not the
onlysourceofpoliticalin sight.Eachofushaswithinourverycoresomething
thatcouldbedescribedaspolitical.Consider,forexample,theviewsthatwe
have of each other. Can we trust each other to do what is right? Should the
government help those who are unable to help themselves or should every
personberesponsiblefortheirownwelfare?Thesearepoliticalquestions.In
ordertoanswerthesequestions,itisnotnecessarytohaveadetailedknowl-
edgeofpoliticalpartiesorthelatestgovernmentinitiative.Farmoreimportant
is that we see ourselves in relation to others, as members of the community
andascitizenswitharangeofrightsandresponsibilities.
Key questions
Sowhatkindofquestionsshouldweconcernourselveswith?Theanswerto
this depends upon who are the main participants, stakeholders or actors. If
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2 KEYDEBATESINHEALTHCARE
we were interested in the internal workings of the National Health Service
(NHS) then we would need to identify where power resides in the service,
whichgroupsmakethedecisionsandhowthesedecisionsareimplemented.
Wehavechosen,however,tolookintheoppositedirection.Ratherthanlook-
inginwardsatanorganizationliketheNHS,wehavechosentolookatsociety.
Thequestionsweaskareframedsothatwecanexplorewaystounderstand,
manageandimprovethehealthofeachofus.Inthisbook,wewillbelooking
atsuchquestionsas:
(cid:2)
Whoisresponsibleforthehealthofthenation?
(cid:2)
Doesthisresponsibilityliewitheachindividualorishealthasocial
conditionforwhichgovernmentsshouldassumesomeresponsibility?
(cid:2)
Should the state play a major role in the direction and provision of
healthcareorshouldwerelyrathermoreupontheprivatesectorand
upontheincreasinglyinfluentialvoluntarysector?
(cid:2)
Isthereafairwaytorationhealthcare?
(cid:2)
Towhatextentshouldthestatetacklehealthinequalities?
(cid:2)
Ispreventionbetterthancure?
(cid:2)
Whatkindofrightsshouldpatientshave?
(cid:2)
Whatistheimpactofprofessionalismupontherelationshipsbetween
differentsectionsofthehealthcaresystem?
Thesekeyquestionswillprovideuswithaseriesofwindowsintothepolitics
ofhealthpolicy.
The structure of the book
This book is intended not as a history of health care but as an exploration

of ideas and policies on key problems facing modern health care systems. It
beginswithanexaminationofdifferentmodelsofhealthandthenmoveson
toconsidereightmaindebatesonissuesrangingfromtheroleofthestatein
theprovisionofhealthcaretotherightsofpatients.Thesedebateshavebeen
selectedinthehopethattheywillbeofsomerelevancetopeopletrainingfor
workinhealthcare.Ratherthangointodetailonsomeoftheissuesthatmight
concernhealthcaremanagers(suchasthemechanismsusedtoauditquality
ofprovision)wehaveconcentratedonthoseissuesthatmightresonatemore
withfront-linehealthcareworkers.Thesedebatesinturnaredividedintothe
threemainpartsofthebook:
(cid:2)
thepoliticsofprovision;
(cid:2)
settingpriorities;
(cid:2)
patientsandhealthprofessionals.