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Health system reforms--Toward a framework for international comparisons


  • Twaddle, Andrew C.


Health care reform efforts internationally are focused more on efficiency than on effectiveness or equity. We lack a coherent theoretical framework for understanding those reforms or for engaging in comparative research. This paper presents some theoretical ideas that could contribute to such a framework. A model constructed from expert opinion suggests that hegemonic systems, national systems and medical care systems all contribute, with specific elements identified in each. Three sociological ideas are suggested: a model of trends leading to a fiscal crisis and a crisis and a crisis of alienation; communities, professions and markets as ideal typical organizational alternatives; global post-Fordist and world systems theories; and hegemonic projects. Together these could explain the timing, speed and direction of health care reform efforts throughout the world.

Suggested Citation

  • Twaddle, Andrew C., 1996. "Health system reforms--Toward a framework for international comparisons," Social Science & Medicine, Elsevier, vol. 43(5), pages 637-654, September.
  • Handle: RePEc:eee:socmed:v:43:y:1996:i:5:p:637-654

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    Cited by:

    1. Kelley Lee, 2014. "Health Policy in Asia and the Pacific: Navigating Local Needs and Global Challenges," Asia and the Pacific Policy Studies, Wiley Blackwell, vol. 1(1), pages 45-57, January.
    2. Gonzalez Block, Miguel Angel, 1997. "Comparative research and analysis methods for shared learning from health system reforms," Health Policy, Elsevier, vol. 42(3), pages 187-209, December.
    3. Williams, Allison M. & Caron, Michelle V. & McMillan, Maria & Litkowich, Anne & Rutter, Noreen & Hartman, Arlete & Yardley, John, 2001. "An evaluation of contracted palliative care home care services in Ontario, Canada," Evaluation and Program Planning, Elsevier, vol. 24(1), pages 23-31, February.


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