STATES FACING INTERESTS - STRUGGLES OVER HEALTH-CARE POLICY IN ADVANCED, INDUSTRIAL DEMOCRACIES

Given alarming fiscal imperatives, states and interests in all advance d industrial democracies have struggled over health care policy. I exp lore the interface between state autonomy in health care policy and th e political mobilization of provider interests, especially physicians. Evidence from Germany, Japan, Canada, and Great Britain suggests that , longitudinally, policy makers everywhere have tried to increase stat e autonomy in health care, and this has generally triumphed over even effectively mobilized providers. The countries that have most successf ully restrained the growth of health care expenditures-while still pro viding ready access to relatively high-quality care-are those where st ates have most actively restrained both demand- and supply-side system interests in policy making. In each country, states have increasingly articulated their own greater capacities in health care policy, pushe d to do so by the imperatives, especially fiscal, embedded in the poli cy domain.