Beyond Rhetorical Differences: A Cohesive Account of Post-devolution Developments in UK Health Policy
Beyond Rhetorical Differences: A Cohesive Account of Post-devolution Developments in UK Health Policy
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DOI：
10.1111/j.1467-9515.2011.00830.x
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发表时间：
2012-04-01
影响因子：
3.2
通讯作者：
Hellowell, Mark
中科院分区：
文献类型：
--
作者：
Smith, Katherine;Hellowell, Mark
健康或许是下放给北爱尔兰、苏格兰和威尔士决策者的最重要的政策领域。因此，人们对评估自1999年以来卫生政策（在权力下放之前就已存在一些差异）的分歧程度产生了极大兴趣。到目前为止，分析往往侧重于医疗保健政策或特定的公共卫生问题（例如健康不平等或烟草控制）。从这一系列研究中得出的结论表明，医疗保健政策存在显著差异，而公共卫生政策则惊人地相似。本文是首批将医疗保健和公共卫生政策一并考虑的文章之一。它重新评估并更新了先前的分析，纳入了与2010年大选以及2007年和2011年权力下放行政机构选举相关的发展情况。通过参考各种文本资料（政策文件、研究证据和企业文献），我们的研究结果与现有分析不同，我们认为，尽管在政策言辞上存在一些明显差异，但提供医疗保健和解决公共卫生问题的方法仍然相似。展望未来，文章得出结论，共同的经济挑战，加上紧缩的财政政策（该政策仍不在权力下放范围内），意味着英国各地在医疗保健提供方面的相似之处可能比差异更为显著。然而，当前关于宪法解决方案的辩论，特别是权力下放行政机构获得更大财政自由的前景，可能为卫生政策出现比以往更有意义的分歧提供机会。
Health is perhaps the most significant policy area to be devolved to decision-makers in Northern Ireland, Scotland and Wales. Consequently, there has been a great deal of interest in assessing the extent to which health policies (which already differed somewhat prior to devolution) have diverged since 1999. To date, analyses have tended to focus either on health care policies or on specific public health issues (e.g. health inequalities or tobacco control). The story that emerges from this body of work suggests health care policies have diverged significantly, whilst public health policies have remained remarkably similar. This article is one of the first to consider health care and public health policy alongside each other. It reassesses and updates previous analyses, incorporating developments relating to the 2010 general election and the 2007 and 2011 devolved administration elections. Drawing on a variety of textual sources (policy documents, research evidence and corporate literature), our findings differ from existing analyses in suggesting that, despite some noticeable differences in policy rhetoric, approaches to both health care provision and tackling public health problems remain similar. Looking to the future, the article concludes that the common economic challenges, combined with a tight fiscal policy (that remains excepted from devolution), means the similarities in health care provision across the UK are likely to remain more pronounced than the differences. However, current debate about the constitutional settlement, and in particular the prospect of greater fiscal freedoms for the devolved administrations, may provide opportunities for more meaningful divergence in health policy than has been possible hitherto.