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This study evaluates whether sociodemographic characteristics, political affiliation, family-related circumstances, self-reported health status, and access to health insurance affect public opinion toward the current US health-care system. Opinions about the health-care system were measured in terms of consumer confidence and perceived need for health-care reform. Data come from the 2008 Cooperative Congressional Election Study (CCES), a nationwide survey of 1,000 respondents. All data were collected in November 2008, thus providing a useful alternative to volatile polling data because they were collected prior to and are thus immune to the polarized tone of the debates that have occurred over the past few years. Overall, we found that public confidence in medical technology and quality of care were consistently high, while confidence in the affordability of medical care was much lower among respondents. Younger adults, those with poor health, and those without health insurance had particularly low confidence in their ability to pay for health care. Although a strong majority of the population agreed that the US health-care system was in need of major reform, support for particular types of government-sponsored health insurance programs was primarily determined by political affiliation. In an era where a large proportion of the population has little access to health care (due to lack of insurance) and where the US government is facing tremendous opposition to the implementation of major reform efforts, it is useful to understand which subgroups of the population are most confident in the current health-care system and most likely to support reform efforts, as well as those who are most resistant to change given their precarious health needs, their inability to access health care (as a result of insurance or noninsurance), or their political affiliation.

The two East Asian developmental states of Japan and South Korea share very similar familialistic male breadwinner welfare regimes. However, in the recent years, both countries have made significant social policy reforms that are gradually modulating their familialistic male breadwinner welfare regimes. Both countries have extended public support for the family and women by provisioning, regulating, and coordinating childcare, elder care, and work‐family reconciliation programs. At the same time, labour market deregulation reforms have also made employment more insecure, and created greater pressures on women to seek and maintain paid work outside the home. The purpose of this paper is to compare recent social policy reforms in Japan and Korea and discuss their implications for welfare state changes and gender equality. More specifically, it asks whether this signals the end of the old developmental state paradigm and a shift to a more gender equal policy regime.

To answer this question, the paper examines recent social policy reforms in conjunction with economic and labour market policy reforms that have also been introduced since 1990.

The analysis of social and economic policy reforms in Japan and South Korea shows a combination of both progressive and instrumentalist motivations behind social care expansions in these countries. Social care reforms in both countries were responses to the evident need for more welfare and gender equality determined by the structural and ideational changes that were taking place. But they were also a remodelling of the earlier developmental state policy framework. Indeed, social care expansions were not merely timely family friendly social policies that aimed to address new social risks; they were also important complements to the employment policy reforms that were being introduced at the same time. By investing in the family, the Japanese and Korean governments sought to mobilize women's human capital, encourage higher fertility, and facilitate job creation in social welfare and care services.

This paper shows how Japanese and South Korean developmental states might be changing and remodelling themselves in the recent decades, and how new social policies are evolving in close coordination with economic and labor market policy reforms.

The purpose of this paper is to examine the planning of the National Health reform – especially the “guarantee for care” reform within it – from the perspective of the concept of wicked problems. This concept asserts that it is of the utmost importance to see the true level of complexity of the problems in order to survive them. The paper tries to the answer the question of how the planners of the health care reforms see the problems they are trying to solve.

This is an interview study. A total of 12 people who participated in the planning of the examined reforms at some level were interviewed. The interview method was a semi‐structured thematic interview. The research analysis is theory‐originated content analysis.

The hypothesis is that the planners of the examined reforms do not focus enough on the complexity of the problems they tried to solve. The research, however, shows that the wickedness of the problems was often noticed. Unfortunately it was not taken as seriously as it should have been. In other words, the planners mostly saw that the problems were very complex, but even then the solutions were only like solutions for tame problems or messes.

The paradigm shift from Newtonian science – which sees the world as a deterministic system – to a more complexity‐endorsing view is on its way. The world is a dynamic and open system, which cannot be controlled. The paper makes its own contribution, from the perspective of health care problems and reforms, to advance this paradigm shift.

This article proposes principles for reforming English adult social care by drawing on the experiences of other countries. These illustrate how the funding, organisation and delivery of services could be reformed, and shed light on the potential political and social factors affecting implementation of reforms.Reforms in other countries are commonly driven by the desire to develop and/or maintain universal access to social care. Formerly fragmented, un‐co‐ordinated and locally variable arrangements are being replaced with universal schemes, with national eligibility arrangements applicable to everyone regardless of age or ability to pay. Cash payments (personal budgets etc) instead of services in kind are widely used. However, such options can have different aims, including supporting family carers and stimulating local provider markets, as well as offering ‘consumer’ choice. Policies for family carers are usually integral to overall long‐term care arrangements. Finally, even in federal systems like Germany, Austria, Spain and Australia, central governments play a crucial role in ensuring universal, equitable and sustainable social care. Central government leadership: maximises risk pooling; enhances budgetary control mechanisms; safeguards equity and quality control; and provides political legitimacy.

This chapter provides an introduction to Volume 29, Health-Care Delivery and Reform: Roles of Patients and Providers. This chapter discusses the topic of health-care systems and health-care reform from an American perspective and also focuses on the roles of patients and providers and how recent sociological literature examines some of these issues. It also serves as an introduction to the volume. It explains the organization of the volume and briefly comments on each of the chapters included in the volume.

The Health Service Executive in Ireland seeks to further develop healthcare in the community. It has identified that this reform requires developing leadership amongst the staff. This study aims to identify what kind of leadership staff in community healthcare observe in practice and their leadership preferences. The core objective has been to identify the readiness of the organisation to implement the adopted national policy of integrated community care reform in terms of leadership development.

An online cross-sectional survey was conducted using the Organisational Cultural Assessment Instrument, based on the Competing Values Framework. This tool identifies four overarching leadership types: Clan (Collaborative), Adhocracy (Creative), Market (Competitive) and Hierarchy (Controlling). Participants (n = 445) were a representative sample of regional community health care employees. They were asked to identify presently observed leadership and preferred leadership in practice. The statistical analysis emphasised a comparison of observed and preferred leadership types.

Participants reported the current prevailing leadership type as Market (M = 34.38, SD = 6.22) and Hierarchical (M = 34.38, SD = 22.62), whilst the preferred or future style was overwhelmingly Clan (M = 40.38, SD = 18.08). Differences were significant (all p’s < 0.001). The overall outcome indicates a predominance of controlling and competitive leadership and a lack of collaborative leadership to implement the planned reform.

During reform in healthcare, leadership in practice must be aligned to the reform strategy, demonstrating collaboration, flexibility and support for innovation. This unique study demonstrates the importance of examining leadership type and competencies to indicate readiness to deliver national community health care reform.

In this chapter, we focus on the major reforms intended to ensure the sustainability of health care in Denmark between 2000 and 2020 and the evidence for the effectiveness of these reforms. We take a broad definition of sustainability and include reforms that aimed to improve the productivity of the health care sector both in terms of increasing activity for the same set of inputs and in terms of improving the quality of care. A characterisation of the Danish health care system as having gone through evolution rather than revolution (Pedersen, Christiansen, & Bech, 2005) is, with one exception, still true today, and reforms have been relatively few. As we demonstrate there is a relative lack of formal evaluations of these reforms.

In the first decade of the period, the majority of new policy measures aimed to increase the quantity of care provided by the health care sector. With the introduction of diagnosis-related groups (DRGs) to measure hospital activity, a wave of reforms created a stronger link between activity and hospital reimbursement, and introduced additional incentives for increasing activity, alongside requirements for increased technical efficiency. A centralisation reform in 2007 reduced the number of administrative units and saw the beginning of a development that would also lead to fewer hospital units. Procurements of medicines were professionalised, and a national council was established to consider the use of expensive hospital medicine.

In the second-half of the period, policy makers began questioning whether increased activity was always for the better, and slowly began experimenting with initiatives that would shift the focus to the quality and appropriateness of care. As in many other countries, this move occurred in the light of a realisation of a shift in the demographic structure of the country and the change this was expected to create for the future demand for health care.

Although some empirical evidence exists, it is striking that few of the changes to the health care sector has been subject to formal academic evaluation – especially when considering the availability of high quality nationwide micro data. We point to a number of important lessons that could be drawn from the Danish experiences.

However, the greatest potential for research into the sustainability of health care in the Danish setting is probably still to be realised by taking advantage of the possibilities of linking micro data on individuals' health care utilisation, schooling outcomes and labour supply, with the possibility of following individuals across decades. For example, Danish micro data make it possible to follow newborns in 1990 until they reach adulthood and simultaneously follow their parents from adulthood until they reach 60 years of age where the prevalence of chronic diseases begins to show.

The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals.

The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel.

We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement (cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.

This paper aims to analyse health reforms carried out in a sample of European countries.

Using a country‐specific approach, outstanding health reform features such as: greater competition between sickness funds in Germany; fund‐holding practices in the UK; managed care models in Switzerland; health networks in France; and healthcare system decentralisation in Italy are analysed.

There have been different approaches to controlling healthcare costs. Some states relied on public sector competition by creating quasi‐markets (UK), insurance sector competition, particularly in Switzerland and Germany, organisational reforms in France by creating health networks and decentralisation in Italy.

Societal and legal aspects are not discussed.

The paper compares healthcare reform effectiveness in a number of western European countries.

The purpose of this paper is to explore, 14 years since the introduction of market reforms, the extent to which changes have altered the nature of Sweden's health care financing, examine how these changes have affected the views of Sweden's physicians, and to judge the impact of these reforms on the delivery and quality of care.

Swedish physicians', Federation of County Council members' and health economists' views, were explored. The data were obtained from in‐depth interviews with 31 respondents in the summer of 2005. The sample was drawn from Stockholm County and the Skane Region.

The respondents generally believed that the Swedish health care system basic structure had remained intact and that several early 1990s reforms, to introduce financial incentives into health care system, had worked well. The diagnostic‐related groups system, though not popular among some health care providers, seemed to have worked for the purposes intended. The majority of Swedish physicians interviewed expressed general satisfaction with their work. Several praised the internal reforms as contributing to more stable health care expenditures, which are low compared with other countries. A majority of respondents supported the care guarantee provisions.

This paper points out that Sweden is showing what governments can do in a global society where access to health care is paramount. All Swedes can feel proud of a well‐planned health care system.