Reshaping the Health-Care State

Abstract

Health Care Has Been Called ‘The World's Most successful industry’. That success is long-standing. In every nation for which we have reliable long-term evidence the proportion of Gross National Product devoted to health care is much higher than was the cast a generation ago. The state has been central to that expansion. In all advanced industrial nations it regulates health care industries; in many it pays most of the cost of care; and in some it directly employs those who do the caring. In the 1980s, however, most countries tried to slow down the growth of health care spending, or even to cut it absolutely. The ‘health care state’ is as a consequence being reshaped across the advanced capitalist world: its power structures are changing; the conditions under which it funds and delivers services are being altered; and its relations with the ‘consumers’ of care are being transformed.