Commercial influence and the content of medical journals.
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Biomedical subjects
Publications and source records attributed to Donald W Light.
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The context for contemporary research and policy is set through a theoretically informed history of the modern American health care system that draws on the concept of countervailing powers and Fligstein's theory of control. In this context, the papers of this special issue are then introduced.
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Britain's National Health Service (NHS) was established in the wake of World War II amid a broad consensus that health care should be made available to all. Yet the British only barely succeeded in overcoming professional opposition to form the NHS out of the prewar mixture of limited national insurance, various voluntary insurance schemes, charity care, and public health services. Success stemmed from extraordinary leadership, a parliamentary system of government that gives the winning party great control, and a willingness to make major concessions to key stakeholders. As one of the basic models emulated worldwide, the NHS-in both its original form and its current restructuring-offers a number of relevant lessons for health reform in the United States.
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Although leadership is typically seen as coming from the leaders of governments and major institutions, a strong case can be made that concerned citizens first articulate important issues and policies that official leaders then pick up and promote. In a market-based society dominated by large corporations, Hirschman's framework of exit, voice, and loyalty can be used to relate consumer and grassroots movements to markets, when participants believe there is no exit and loyalty (or acquiescence) is not an option. While "voice" is usually applied to the individual or consumer level, this article develops the concept of organized voice and illustrates how it has exhibited leadership in the controversial relations between the biotech and pharmaceutical industries and society as a whole. The essay concludes by urging more research on organized voice as a source of leadership and by outlining some important dimensions for researchers to consider.
Universal access to health care has historically faced strident opposition from political conservatives in the United States, although it has long been accepted by most conservatives in the rest of the industrialized world. Now, in a global economy where American business is crippled by the rising cost of market-based health care, the time may be ripe for change. The key to fostering a new mindset among American conservatives is to show why universal access fulfills many of the basic values that all conservatives hold.
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