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Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales / David, Hughes
Journal of Health and Social Behavior, Volume: 49, Issue: 4, Pages: 400 - 416
Swansea University Author: David, Hughes
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In the wake of devolution, the four countries of the United Kingdom pursued strikingly different National Health Service (NHS) reforms. While England created a supply-side market more radical than the previous internal market system, Wales moved to a softer version of the purchaser/provider split. T...
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In the wake of devolution, the four countries of the United Kingdom pursued strikingly different National Health Service (NHS) reforms. While England created a supply-side market more radical than the previous internal market system, Wales moved to a softer version of the purchaser/provider split. This article deploys institutional theory to analyze the forces shaping change, and describes the hybrid forms of economic organization emerging, including the economic regulation model implemented in England. The schism has resulted in separate NHS subsystems and warrants a different analysis from the more familiar phenomenon of infield divergence. We argue that schism was triggered by political-regulatory influences rather than economic or other social institutional forces, and predict that other decentralized public health care systems may follow a similar path. While political-regulatory, normative, and cognitive institutional influences push in the same direction in Wales, the misalignment of political-regulatory and normative elements in England looks set to result in a period of organizational turbulence.
a. The author made a substantial contribution either to all aspects of the study and (b) took the lead in writing the paper. Journal IF 3.333, 5 year IF 4.025, 7 of 136 Public Health, 4 of 40 Social Psychology, citations Google Scholar 14. JHSB is the health journal of the American Sociological Association, which rarely publishes UK material. Overview of England/Wales policy divergence based on qualitative interviews and using institutional sociology theory. Has been used as background paper for my three recent research projects that all have an England/Wales comparative dimension.
College of Human and Health Sciences