Main description:

One of the most persistent puzzles in comparative public policy concerns the conditions under which discontinuous policy change occurs. In Remaking Policy, Carolyn Hughes Tuohy advances an ambitious new approach to understanding the relationship between political context and policy change. Focusing on health care policy, Tuohy argues for a more nuanced conception of the dynamics of policy change, one that makes two key distinctions regarding the opportunities for change and the magnitude of such changes. Four possible strategies emerge: large-scale and fast-paced ("big bang"), large-scale and slow-paced ("blueprint"), small-scale and rapid ("mosaic"), and small-scale and gradual ("incremental"). As Tuohy demonstrates, these strategies are determined not by conditions themselves, but by the ways in which political actors, individually and collectively, assess their prospects for success in the present and over time.
Drawing on interviews as well as primary and secondary accounts of ten cases of major change in health policy over seven decades (1945-2015) in the US, UK, the Netherlands, and Canada, Remaking Policy represents a bold step toward understanding the scale and pace of change in health policy and beyond.

Contents:

Part I: Overview and theory Chapter One: Overview Chapter Two: Defining the Scale and Pace of Policy Change Part II: The Founding and Evolution of the Health care State to the 1980s Chapter 3: The Establishment and Evolution of the British and American Health Care States to the 1980s Chapter Four: The Establishment and Evolution of the Dutch and Canadian Health Care States to the 1980s Part III: remaking the Health Care State at the Millennium, 1987-2015 Chapter Five: British and American Health Care Reform Strategies, Late 1980s to Late 2000s Chapter Six: The American Mosaic 2009-2014 - Return to Unfinished Business Chapter Seven: The English Mosaic 2010-2014 - Evolution in Revolutionary Clothing Chapter Eight: The Dutch Blueprint 1987-2006 Chapter Nine: Canadian Incrementalism Reinforced, 1995-2004 Part IV: institutional entrepreneurs and the course of Market-oriented reform Chapter Ten: Institutional Entrepreneurs and Market-Based Reform: Theory and Experience in Britain, the Netherlands and the US Part v: Conclusion Chapter Eleven: Understanding Policy Change