Explaining Change in the Welfare State and in Health Care Policy

Abstract

The central concern of this chapter is how one attempts to interpret changes in health care policy. At one end of the spectrum some commentators appear to suggest that developments in the NHS merely reflect changes elsewhere in the economy; thus, changing patterns of labour organisation (Chapter 6) or subcontracting of work (Chapter 8) represent a translation to the NHS of more widespread economic changes. Likewise technological developments (the enhanced capacities of contemporary medicine and information technology) are said to require and facilitate the implementation of market-based reforms. Conversely, at the opposite end of the political spectrum, events in the welfare state are interpreted in terms of a ‘crisis’ in state welfare, or the ‘restructuring’ of welfare in the interests of capital, or are even linked to a covert agenda to privatise the service.