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 analyzing 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:

• changes in the quality, efficiency and costs of care
• growing managerial and political control over physicians and other health care professionals
• increased influence and centrality of community-based care
• Diffusion 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 in the United States and many other countries. The book will be of value to students, researchers, and practitioners in health policy and public policy.

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