Dynamics of a changing health sphere: the United States, Britain, and Canada

Different patterns of change in the American, British, and Canadian health care systems in the 1990s result from the particular logic of each system. Different balances of influence across major categories of actors, and different mixes of hierarchical, market-based, and collegial instruments have different implications for lines of accountability and for information costs, and thus create different incentives that shape behavior. Market instruments functioned differently when introduced into Britain's system of "hierarchical corporatism" than in the American mixed-market system. Profession/state accommodations in Britain and Canada tempered the pace of change, while the entrepreneurial logic of the U.S. system generated a turbulent transformation.