One: Key challenges facing health systems


The reader may wonder why another book on health policy is deemed necessary given the numerous texts already available, many of them updated versions of earlier ones. It is a fair question, particularly when this text is a second edition and falls into that category. In its defence, it attempts to do a different job. The aim of the book is to explore four key contemporary debates evident in health systems and consider how they have shaped the way in which such systems have evolved over time and continue to evolve. It is not a traditional comparative text since its principal focus is on health policy developments in the UK, with selective use made of examples from other countries and health systems where appropriate and of particular illustrative value. Most of the examples from outside the UK are drawn from other European health systems as well as from arrangements in North America, Australia and New Zealand.

The British NHS celebrated its 67th birthday in July 2015, but this book is not a history of its development or achievements over this period. Many existing texts already admirably serve this purpose, notably Baggott (2004), Ham (2004) and Klein (2006), and there is little to be gained by going over much the same ground, although there is some inevitable overlap. However, what sets the present book apart is a focus on a number of what might be termed policy cleavages that are evident in health and health care policy and in the development of health systems, and which are the subject of lengthy, often acrimonious and inconclusive, debate. The book is structured around four of these cleavages. They are:

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