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Health Policy in the Welfare State: National Responses to AIDS in the United States and the United Kingdom
Unformatted Document Text:  The United States and United Kingdom represent opposite ends of the continuum on each of these variables. As we have seen, the U.S. system is composed of a decentralized, fragmented, and largely private set of institutions. Health care is financed and delivered through a variety of public and private mechanisms that together cover most of the population but yield very different care for different groups of people. Decisions about medical services are made by national, state, and local governments, as well as by private corporations. In contrast, health care in the U.K. is organized and delivered almost entirely through the National Health Service (NHS) – a universalistic institution that is the sole provider of most medical services for the vast majority of the population 7 . The NHS is financed publicly through national tax revenues, and decisions about revenue intake and the distribution of expenditures are made at the national political level. Medical care is controlled by a hierarchical structure that links local practice to regional and national decision-making. Given the structural differences between the U.S. and U.K. systems, I expect to find quite distinct AIDS policy-making environments and policy outcomes in the two nations. In particular, I hypothesize that the U.K. case will reflect five important differences: a more consistent sense of national responsibility for AIDS care, a universalistic approach to service planning, more explicit and specific national policies, earlier and more comprehensive inclusion of preventive treatment, and a more focused concentration of debate about the provision of expensive treatments. In the U.S., social responsibility for medical care is fragmented and often unclear. Depending on who is affected, the costs of treating a new disease may accrue to 7 There are private healthcare providers in the U.K., but they form a marginal supplement to the NHS, which dominates the health care system. All citizens are covered under the NHS; there are no eligibility rules or insurance verifications between patient and provider. Private practitioners are not allowed to offer any services provided by the NHS, guaranteeing that the NHS remains the single payer and provider of most medical services in the country. 31

Authors: Padamsee, Tasleem.
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The United States and United Kingdom represent opposite ends of the continuum
on each of these variables. As we have seen, the U.S. system is composed of a
decentralized, fragmented, and largely private set of institutions. Health care is financed
and delivered through a variety of public and private mechanisms that together cover
most of the population but yield very different care for different groups of people.
Decisions about medical services are made by national, state, and local governments, as
well as by private corporations. In contrast, health care in the U.K. is organized and
delivered almost entirely through the National Health Service (NHS) – a universalistic
institution that is the sole provider of most medical services for the vast majority of the
population
. The NHS is financed publicly through national tax revenues, and decisions
about revenue intake and the distribution of expenditures are made at the national
political level. Medical care is controlled by a hierarchical structure that links local
practice to regional and national decision-making.
Given the structural differences between the U.S. and U.K. systems, I expect to
find quite distinct AIDS policy-making environments and policy outcomes in the two
nations. In particular, I hypothesize that the U.K. case will reflect five important
differences: a more consistent sense of national responsibility for AIDS care, a
universalistic approach to service planning, more explicit and specific national policies,
earlier and more comprehensive inclusion of preventive treatment, and a more focused
concentration of debate about the provision of expensive treatments.
In the U.S., social responsibility for medical care is fragmented and often
unclear. Depending on who is affected, the costs of treating a new disease may accrue to
7
There are private healthcare providers in the U.K., but they form a marginal supplement to the NHS,
which dominates the health care system. All citizens are covered under the NHS; there are no eligibility
rules or insurance verifications between patient and provider. Private practitioners are not allowed to offer
any services provided by the NHS, guaranteeing that the NHS remains the single payer and provider of
most medical services in the country.
31


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