title: Health system reforms--toward a framework for international comparisons.
abstract: 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 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.
authors.affiliation: University of Missouri, Department of Sociology, Columbia 65211, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Twaddle
mesh_terms: D003906:Developing Countries; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007391:International Cooperation; D017146:Models, Organizational; D009313:National Health Programs; D012959:Socioeconomic Factors