Health affairs
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The Labour government's 1997 plans for Britain's National Health Service (NHS) have been presented as a reaction to the reforms introduced by its Conservative predecessor in 1991. But to a large extent they build on the Conservative legacy. ⋯ Welcomed when published, Labour's plans may arouse opposition in implementation, for they imply greater central control and threaten medical autonomy. If the political costs are to be contained, Labour may have to choose between increasing spending on the NHS or making concessions to the medical profession--and quite possibly have to do both.
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The Health Insurance Portability and Accountability Act (HIPAA) of 1996 has been praised and criticized for asserting federal authority to regulate health insurance. We review the history of federalism and insurance regulation and find that HIPAA is less of a departure from traditional federal authority than it is an application of existing tools to meet evolving health policy goals. ⋯ We also report on the insurance environments and the HIPAA implementation choices of thirteen states. We conclude with criteria for judging the success of HIPAA and the evolving federal/state partnership in health insurance regulation.
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Health system reform, in Europe as elsewhere, has often been influenced as much by theory and conjecture as by fact and experience. In a study published in September 1997, the Regional Office for Europe of the World Health Organization (WHO) drew together the available evidence about the health care systems in the fifty-one countries of the European region. ⋯ It reviews a variety of policy strategies and then explores implications from this European experience for the formulation of U. S. health care policy.