Governance of Health Care in Comparative Perspective.

We are accustomed to considering welfare states in terms of nationally determined political institutions, culture and common historical origins. In the area of health policy we usually refer to ‘national’ health insurance and national health services. Yet much of health policy is concerned with resolving how services will be organized and distributed spatially. Conflicts tend to arise over which unit of government is responsible for payment or regulation of areas of health care between national and sub-national levels. These conflicts may arise particularly when national governments want to shift control from one area to another but have included situations such as central government wanting to distribute care of the sick during a war, in order to placate physicians, to satisfy groups or voters in particular areas, or to protect the fiscal solvency of central government, or both. Governments may want to concentrate expensive technology or services, or focus areas of medicine in specific places. Generally, hospitals and communities are eager to keep their independence for as long as possible. [ABSTRACT FROM AUTHOR]