1. Understanding the dynamics of change in the health care arena The conceptual framework: The accidental logics of change in policy arenas Dimensions of decision-making systems: Institutional mix and structural balance Policy episodes and system logics The economics of health care delivery: Agency, risk, and localism The health policy agenda of the 1990 Britain, the United States, and Canada Part I. Episodes of policy change 2. The establishment of welfare state in the health care arena The immediate postwar period: Britain versus Canada and the United States The 1950 and 1960: The establishment fo governmental health insurance in Canada and the United States 3. The reforms of the 1990 Britain The United States Canada 4. Institutions, ideas, interests, actors, and the accidents of policy episodes Political institutions Policy legacies and path dependendy Public opinion and cultural understandings Political culture and parties Interests Strantegic judgment Understanding policy episodes Part II. The distinctive logics of national systems 5. The United States: The logic of the mixed market Regulation in the 1970 Prospective payment in the 1980 The rise of "managed care" Regional versus National markets The growing role of for-profits Performance monitoring and the role of clinical judgement Information and information technology The changing political terrain Institutional and structural change in the mixed market The logic of entrepreneurialism 6. Britain: The logic of corporatism meets the internal market Corporatism in the NHS Managerialism and the griffiths reforms The purchaser-provider split: Bargaining in the internal market Bargaining roles: The provider side Bargaining roles: The purchaser side Clinical audit and the role of clinical judgment Information and information technology The role of the private sector The role of partisan and electoral politics Institutional and structural change in the internal market The logic of the internal market 7. Canada: The logic of the single- Payer system The founding bargain: Fee-for-service and the negotiation of price Provincial-level accommodations in the 1970 and 1980 Expenditure caps in the 1990 The expanding agenda Information and information technology Changing profession-government relations and the impact on organized medicine The logic of the profession-state accommodation Institutional and structural change in a single-payer system 8. Conclusion The health policy arena in Britain, the United States, and Canada concluding observations