QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Home | Help | Feedback | Subscriptions | Archive | Search | Table of Contents

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (34) Citing Articles via Google Scholar Google Scholar Articles by Evans, R. G. Search for Related Content PubMed PubMed Citation Social Bookmarking                   What's this?

Finding the Levers, Finding the Courage: Lessons from Cost Containment in North America

"Learning" is broader and more complex than simply the orderly acquisition of new knowledge. At least as important is the evolution of the background of assumptions and beliefs held by the community, or its principal decision makers, and implicit in its institutions and policies. These may bear only a loose relation to evidence or knowledge narrowly denned. The pressures of cost escalation over the past twenty years, and the attempts at containment in the U.S. and Canada, have added substantially to our knowledge of how the health care system works. Containment is possible, and the successful mechanisms, thus far, are quite specific. But the results of these attempts and (in the U.S.) the continued escalation have also significantly shifted the broader set of assumptions in the community about appropriate priorities and policies in health care. Attitudes towards physician supply, variations in practice patterns, capitated practice, and for-profit organization, for example, have changed radically, although the supporting evidence has not. But cost pressures have created an audience which wants to hear, whose background assumptions provide a different "fit" for the evidence.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				D. A. Rochefort The Pragmatic Appeal of Employment-based Health Care Reform Journal of Health Politics Policy and Law, January 1, 1993; 18(3): 683 - 693. [PDF]

				R. B. Saltman Single-Source Financing Systems: A Solution for the United States? JAMA, August 12, 1992; 268(6): 774 - 779. [Abstract] [PDF]

				T. Rice Containing Health Care Costs in the United States Med Care Res Rev, March 1, 1992; 49(1): 19 - 65. [PDF]

				J. Lomas Finding Audiences, Changing Beliefs: The Structure of Research Use in Canadian Health Policy Journal of Health Politics Policy and Law, September 1, 1990; 15(3): 525 - 542. [Abstract] [PDF]

				S. Woolhandler and D. U. Himmelstein A National Health Program: Northern Light at the End of the Tunnel JAMA, October 20, 1989; 262(15): 2136 - 2137. [Abstract] [PDF]

				T. S. Bodenheimer Payment Mechanisms under a National Health Program Med Care Res Rev, January 1, 1989; 46(1): 3 - 43. [PDF]

				M. L. Barer Regulating Physician Supply: The Evolution of British Columbia's Bill 41 Journal of Health Politics Policy and Law, March 1, 1988; 13(1): 1 - 25. [Abstract] [PDF]