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Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales

D Hughes, P Vincent-Jones, David Hughes

Journal of Health and Social Behavior, Volume: 49, Issue: 4, Pages: 400 - 416

Swansea University Author: David Hughes

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DOI (Published version): 10.1177/002214650804900403

Abstract

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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Published in: Journal of Health and Social Behavior
ISSN: 0022-1465
Published: Sage 2008
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URI: https://cronfa.swan.ac.uk/Record/cronfa6730
first_indexed 2013-07-23T11:55:19Z
last_indexed 2018-02-09T04:34:13Z
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spelling 2015-05-11T09:32:30.0066157 v2 6730 2012-01-23 Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales f1fbd458e3c75d8b597c0ac8036f2b88 David Hughes David Hughes true false 2012-01-23 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.  Journal Article Journal of Health and Social Behavior 49 4 400 416 Sage 0022-1465 31 12 2008 2008-12-31 10.1177/002214650804900403 http://hsb.sagepub.com/content/49/4/400.short 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 NANME COLLEGE CODE Swansea University 2015-05-11T09:32:30.0066157 2012-01-23T12:41:25.2870000 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Public Health D Hughes 1 P Vincent-Jones 2 David Hughes 3
title Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales
spellingShingle Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales
David Hughes
title_short Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales
title_full Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales
title_fullStr Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales
title_full_unstemmed Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales
title_sort Schisms in the Church: National Health Service Systems and Institutional Divergence in England and Wales
author_id_str_mv f1fbd458e3c75d8b597c0ac8036f2b88
author_id_fullname_str_mv f1fbd458e3c75d8b597c0ac8036f2b88_***_David Hughes
author David Hughes
author2 D Hughes
P Vincent-Jones
David Hughes
format Journal article
container_title Journal of Health and Social Behavior
container_volume 49
container_issue 4
container_start_page 400
publishDate 2008
institution Swansea University
issn 0022-1465
doi_str_mv 10.1177/002214650804900403
publisher Sage
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Public Health{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Public Health
url http://hsb.sagepub.com/content/49/4/400.short
document_store_str 0
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description 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. 
published_date 2008-12-31T18:13:40Z
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score 11.048453

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