This article examines how the rather similar approaches to the management of medical care (which here we term 'scientific-bureaucratic medicine') emerged within the public-policy agendas of both the United Kingdom and United States during the 1990s. In particular, we address the theoretical puzzle of how explanations of policy emergence in single countries can be reconciled with policy convergence between two countries.The positioning of issues on a policy agenda is a key element in explanations of why some decisions, rather than others, are made in modern government. Explaining how issues and particular solutions to them reach the top of a policy agenda has thus become one of the central problems in policy analysis. Decisions to place such items on the agenda plainly involve human agents, but there is a dialectical relationship between the intervention of such agents and the constraining power of institutions and economic structures; structure and agency interact with, and shape, each other. One can investigate such decisions as particular historical episodes, estimating the respective extent to which agency and structure can be
Four sets of reforms of the National Health Service are employed to illustrate the changing character of policy making in this sector over a thirty year period, from the production of a carefully developed technocratic blueprint for its organization to the promulgation of a series of bright ideas accompanied by incentives for local actors to develop them into concrete organizational arrangements consonant with these ideas. We term this latter approach ‘manipulated emergence’ and relate it to the literatures of organizational culture and of post‐Fordism. The approach adopted by the 1997 Labour government is largely, though not wholly consistent with this, and it remains to be seen whether the high‐water mark of manipulated emergence has passed.
The changing role of tutorials and tutors in an age of mass higher education is sketched. The differing purposes of small group teaching are explored; small groups are shown to have a variety of academic and pastoral functions. The mechanics of tutorial organisation are explored and the range of teaching formats examined.
One prominent method for controlling health costs is to find measures for the management of demand. Various options exist for this; and many of them have been tried during the fij?y years of the UK's National Health Service. Current policy now focuses on what may be called "scientific-bureaucratic medicine." This policy is based on the assumptions that valid medical knowledge is derived from accumulated research evidence and that such knowledge should be implemented through clinical guidelines which are enforced to some extent. This UK development has parallels with the US Agency for Health Care Policy and Research whose experience, therefore, raises some policy issues for the UK.This paper examines the recent attempt of UK health policy to achieve savings through an approach to the management of health care demand which we term the "scientific-bureaucratic" model of medical care evaluation. This model can be characterized as
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