Policy Emergence and Policy Convergence: The Case of ‘Scientific-Bureaucratic Medicine’ in the United States and United Kingdom

Abstract

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

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