Events, Public Discourses and Responsive Government: Quality Assurance in Health Care in England, Sweden and Japan

Abstract

One would expect the common agenda of improving the quality of care in hospital sectors across nations to bring about a convergence of their quality assurance systems. However, one finds great variations in the ways in which such schemes are constructed and communicated to the general public in different countries. This paper examines three universal health care systems (England, Sweden and Japan) and explores the degree to which political institutions and public opinions affect the processes of quality assurance system building within them. It argues that the inputs from governments in response to public concerns are the key to understanding the changes in this seemingly profession-dominated policy domain; therefore policy changes are significantly affected by dynamic interactions between events, public discourses and governance structures within these countries. The findings also demonstrate that public access to information have begun to have a large impact on policy debates in all three countries. Do political institutions matter to the development of quality assurance systems in health care?Health care policy-making is a politically contentious area in times of economic downturn in ageing societies. Universal welfare provision is under great strain in contemporary industrially advanced democracies. The three main actors (the state as the principal financier of health care, the public as recipients of health care services, and the medical professions as the service providers) have to constantly Published in Journal of Public Policy, 30, 3, Kodate (2010) 2 negotiate and strike a balance between various policy goals such as equity, cost-effectiveness, and quality of care (Harrison et al. 1990;Moran and Wood 1993; Döhler 1995;Salter 1999;Laegreid et al. 2005).Quality assurance 1 of health care has become a widely-used policy tool in most advanced economies (Pollitt 1987;van den Heuvel et al. 2005); it is accepted as useful for both medical professionals and patients for comparing the performance of different health care providers, in that the former can learn about and emulate best practice, and the latter can make an informed decisions regarding hospital choice (OECD 1993; WHO 2000). Following the rise of new public management in the 1980s (Dunleavy and Hood 1994;Pollitt and Bouckaert 2004), governments began to see quality assessment as a potentially valuable policy instrument for reforming the public sector by enhancing competition, accountability and freedom of choice through the measurement of performance. In some cases, the development of performance indicators in the health sector was linked to the determination of budgetary allocations (OECD 1994).However, this global trend has not yet been transformed into a unified method of measuring clinical outcomes and processes: not even a common definition of quality exists, and the way in which the results are disseminated to the public varies greatly across countries. This paper explains why the variations persist by examining how different health ca...

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