Cover

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Half Title, Series Info, Title Page, Copyright, Dedication

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Contents

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pp. vii-viii

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Acknowledgments

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pp. ix-xii

The book you hold in your hands or see on your screen has been through a long journey, with perhaps an even higher number of twists and turns than are found on the usual scholarly roller coaster. I owe an enormous number of people a debt of gratitude for their support of this project as it evolved and unfolded. ...

List of Abbreviations

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pp. xiii-xiv

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Introduction

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pp. 1-25

On the eightieth anniversary of the British National Health Service (NHS), US physician Don Berwick, an unabashed fan, gave a speech expressing his great love for the NHS. “There comes a time, and the time has come,” he said, “for stability, on the basis of which, paradoxically, productive change becomes easier and faster, as the good, smart, committed people of the NHS— ...

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1. Health Care Systems in the United States and the United Kingdom: A Lifetime of Change

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pp. 26-52

In the United States, a woman who is delivering a baby will face different choices depending on her health insurance status. Around half of births are covered by Medicaid, the government-run health insurance program for the poor (Markus et al. 2013). Other births are covered by private health insurance, which is usually employer-sponsored but may also be purchased individually. ...

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2. Turbulence in the Two Systems

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pp. 53-67

Between the 1970s and the 1990s, managed care came to dominate the American health care landscape. Medicare and Medicaid covered the older and poor populations, respectively, and most Americans received health insurance through their employer or the employer of a family member. ...

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3. Measuring and Rewarding Performance: Imposing Change from above in the United Kingdom

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pp. 68-94

Across health care systems, the drive to monitor and improve performance is everywhere, and the United Kingdom, even with its single-payer system, is no exception. From President Obama’s emphasis on cutting wasteful spending and researching comparative effectiveness, to various public and private hospital rating systems, the quest to understand, measure, and improve performance is pervasive. ...

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4. Regulating the Front Line from Above: The Joint Commission and Hospital Regulation in the United States

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pp. 95-118

Although the casual observer may see that the American health care system is fragmented and market driven, the underlying reality is that it is also highly regulated. Just as in the United Kingdom, in the United States there is a complex, overlapping web of regulating agencies that make crucial decisions in perpetuating the status quo, promulgating change, and incentivizing certain activities and priorities. ...

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5. Pushing Back from the Front Line: Staff Responses to Privatization in the National Health Service

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pp. 119-141

When change is imposed on a hospital from above, frontline staff sometimes push back. Workers and their unions may be unable to halt a major policy change, but they may be able to fight back as the new policy takes effect. A policy may be passed by a legislative body, but the actual implementation is still subject to the interests and influence of the workplace stakeholders. ...

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6. Building a Culture of Safety from the Front Line in the United States

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pp. 142-166

Changes initiated by health care providers constantly take root in individual workplaces, but changes that trickle up from the workplace to the national level are less common. Chapter 5 showed an example of bottom-up change in the United Kingdom, and this chapter continues this theme with examples of bottom-up change initiated in hospitals in the United States. ...

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7. From the Health Care Workplace to the Health Care System: Learning from the United States and the United Kingdom

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pp. 167-174

To look ahead to future changes in the Anglo-American health care systems, this chapter resituates in their national contexts the cases I have discussed in earlier chapters. In both the United Kingdom and the United States there are ongoing changes in the areas of accountability, central regulation, privatization and resistance, and the still-growing safety movement. ...

References

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pp. 175-194

Index

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pp. 195-200