Paths of Progress in Healthcare Reform: The Scale and Pace of Change in Four Advanced Nations
Bibliographic record
Abstract
In the past two decades, three cases of major change in health policy frameworks in advanced nations stand out in comparative perspective: the British “internal market” reforms of the 1990s, the Dutch introduction of universal managed competition among insurers in 2006, and the enactment of a universal mandate for health insurance in the US. Each of these cases represents a substantial shift from the foundational model of the nation’s health care state, either on a large scale, at a rapid pace, or both. The intersection of these two dimensions of scale and pace yields four possible strategies for policy change: big-bang (exhibited by the UK), blueprint (the Netherlands), mosaic (US) and, by default, incremental (exhibited in the current study by the case of Canada). These respective strategies can be understood as the result of judgments made by key actors under particular circumstances in the broader political and institutional context in each nation. Rare conjunctures of forces exogenous to the health care arena create opportunities for major change, but favour different strategies in different contexts. In the absence of such conjunctures, tensions inherent to health care delivery drive a pattern of cycling through established policy repertoires.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.005 | 0.014 |
| Scholarly communication | 0.011 | 0.009 |
| Open science | 0.001 | 0.009 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".