title: A democratic responsiveness approach to real reform: an exploration of health care systems' resilience.
abstract: Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered to explain why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that as a result public resistance to real reform may more accurately reflect citizens' personal convictions, self-interest, or even active social choices. "Conscientious objectors" may do more to derail reform than previously recognized.
authors.affiliation: McMaster University.
authors.forename: Michel
authors.initials: M
authors.lastname: Grignon
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005060:Europe; D015276:Health Care Rationing; D018166:Health Care Reform / Q000379:methods*; D061889:Healthcare Financing; D006801:Humans; D011639:Public Opinion; D012945:Social Values; D035502:Trust; D014481:United States