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Charles/Adam, I agree with Charles re structural reforms of health care systems with implications for management, management tiers and relations (or lack of them!) betwen them. But I would distinguish that from 'major reform' to extend access, address equity etc. Moving 'too incrementally' on the lattercan reinforce the system's 'mobilisation of bias' (Schattschneider, 1960) and entrecnch 'path dependencies' which may need to be challenged. I would also distunguish betwen 'pulling levers because they're there' (the story of New Labour from 1997 to 2007) in a government system and major reform to a non-government non-system! Best as ever Calum CALUM R PATON Professor of Health Policy School of Public Policy and Professional Practice CBA1.054 Keele University Keele, Staffordshire ST5 5BG, U.K. Tel: +44 (0) 1782 734867 Email: [log in to unmask] See: Calum Paton (2006) New Labour's State of Health: Political Economy, Public Policy and the NHS, Ashgate Visit the International Journal of Health Planning and Management online at: www.interscience.wiley.com/journal/hpm ----- Original Message ----- From: "Charles Normand" <[log in to unmask]> To: <[log in to unmask]> Sent: Wednesday, January 07, 2009 9:34 AM Subject: Re: Reform > Adam > > I am not sure either what major reform is meant in this context, but my > fear > is always that the effect of major reform is to make so many changes so > fast > that the whole system takes years to recover. The three year rule is that > it takes at least this long for the system to be no worse than it was > before > the changes began. In some cases this makes things so much worse that a > need > is perceived for another major reform. If the new team has an ounce of > sense between them they will opt for a Norwegian style of problem solving > rather than system reform - the main difference is that this is based on a > clear understanding of the usefulness of each element of change and almost > no fanfare. > > Charles Normand > Edward Kennedy Professor of Health Policy & Management > University of Dublin > Trinity College > 3-4 Foster Place > Dublin 2 > +353 1 896 3075 > -----Original Message----- > From: Anglo-American Health Policy Network [mailto:[log in to unmask]] > On > Behalf Of Adam Oliver > Sent: 22 December 2008 19:09 > To: [log in to unmask] > Subject: Reform > > Fyi, although can someone tell me what 'major reform' is? I have no idea - > good job no-one rings me to ask these types of questions. I suspect for > most > people it means "I want cheaper health care coverage for me, now", or "I > want the Government to do obviously good things so long as I don't have to > pay for it.". But perhaps I'm being too cynical. > > > OBAMA: Majority Supports Major Reforms to Health Care System > > > A majority of U.S. adults believe that President-elect Barack Obama should > make major reforms to the health care system, according to a recent > Washington Post-ABC News Poll, the Post > <https://exchange.lse.ac.uk/exchweb/bin/redir.asp?URL=http://www.washingtonp > ost.com/wp-dyn/content/article/2008/12/20/AR2008122001498.html> reports > (Cohen/Agiesta, Washington Post, 12/21). The poll, conducted by telephone > between Dec. 11 and Dec. 14, included responses from a random sample of > 1,003 adults. The poll has a margin of error of plus or minus three > percentage points. Seventy-seven percent of adults believe that Obama > should > make major reforms to the health care system, compared with 20% who > believe > that he should not, the poll found. According to the poll, among adults > who > believe that Obama should make major reforms to the health care system, > 51% > believe that he should seek to make such changes immediately after he > takes > office, and 26% believe that he should wait until later in his presidency. > Sixty-eight percent of adults believe that Obama will have the ability to > make major reforms to the health care system, compared with 28% who > believe > that he will not have the ability, the poll found. Almost three-fourths of > adults believe that Obama should increase federal funds for health > insurance > for children, compared with 23% who believe that he should not, according > to > the poll. Among adults who believe that Obama should increase federal > funds > for health insurance for children, half believe that he should address the > issue immediately, compared with 24% who believe that he should wait, > according to the poll. In addition, 52% percent of adults believe that > Obama > should increase federal funds for embryonic stem cell research, compared > with 42% who believe that he should not, the poll found (Washington Post > graphic > <https://exchange.lse.ac.uk/exchweb/bin/redir.asp?URL=http://www.washingtonp > ost.com/wp-dyn/content/story/2008/12/21/ST2008122100258.html> , 12/21). > > > > Please access the attached hyperlink for an important electronic > communications disclaimer: > http://www.lse.ac.uk/collections/secretariat/legal/disclaimer.htm >