Archives
Economism, managerialism and health care
Neville Hicks
Department of Community Medicine, The University of Adelaide
Abstract
Marianne Weber's biography of her husband has a delightful story of Weber's service as a volunteer administrator in the Heidelberg Military Hospital during the first world war. Max Weber's final report on his work emphasised the importance of professional bureaucratic administration. Sheila Hillier includes the story in the opening paragraphs her account of his contribution to understanding modern health care systems before elaborating on Weber's important distinction between wertrational, or moral action, motivated by a belief in the intrinsic value of doing something; and zweckrational, or technical action, involving 'calculation of the appropriate action to be taken to achieve a desired end' (Hillier 1987).
In the end constructing a 'good' health service is a moral problem, not a technical one, but the contemporary pressure is all the other way. Weber feared that the technical would become the predominant form of 'rational' action in modern society and would be expressed through an iron cage of bureaucracy which would lock away questions about ultimate values. Pusey's study of life among the bureaucrats in Canberra reports on the current strength of the cage (Pusey 1991). He argues that the bureaucracy has made a major shift during the last thirty years, from a general interest in what kind of society Australia might be and how that society might be achieved, to a doctrinaire interest in whether the diversities of life in Australian society are consistent with the demands of 'The Economy'.
References
Anderson, E. (1993) Value in Ethics and Economics, Harvard: Harvard University Press.
Ashmore, M., Mulkay, M. And Pinch, T. (1989) Health and Efficiency: A Sociology of
Health Economics, Milton Keynes: Open University Press.
Asimakopolus, A. (1985) 'Microeconomics' in A & J. Kuper (Eds) The Social Science
Encyclopedia, London: Routledge, Keegan Paul.
Australia, Department of Health and Human Services, General Practice Branch (1993)
Divisions and Project Grants Program, 1994-95. Application Reference Manual,
Canberra: Department of Health and Human Services.
Australian Community Health Association [Ian Lennie].(1991) 'Response to 'Hospital
Services in Australia - Access and Financing..." Sydney: Mimeo ACHA
Backhouse, P. (1994) Medical Knowledge, Medical Power. Doctors and health policy
in Australia, Adelaide: University of Adelaide, PhD thesis.
Battin, T. (1991) 'What is this thing called economic rationalism?' Australian Journal of
Social Issues 26(4), 294-307.
Boyce, J. (1990) 'Health Consultancy: Can The Academics Get In?', Critical Public
Health 3 14-19.
Brindle, D. (1995) 'Boom in NHS Managers', Guardian Weekly, October 22.
Bryson, L. (1986) 'A New Iron Cage? Experience of Managerial Reform.' Adelaide:
Flinders University of South Australia Mimeo.
Carr-Hill R. et al. (1991) 'Morbidity Variation and RAWP', Journal of Epidemiology and
Community Health 44 271-273.
Considine, M. (1987) 'The Corporate Management Framework as Administrative
Science: A Critique' in Australian Journal of Public Administration 46(1) 4-18
Considine, M. (1992) 'Policy: managed or Expert', in Gardiner, H (ed) Health Policy.
Development, Implementation and Evaluation in Australia, Melbourne: Churchill
Livingstone 29-50.
Day, P. & Klein J. (1991) 'Britain's Health Care Experiment' in Health Affairs 10(3) 39-
59.
Deeble, J. & Lewis Hughes, P. (1991) Directions for Pathology, National Health Strategy
Background Paper No. 6.
Deeble, J.S. (1991) Medical Services through Medicare, National Health Strategy
Background Paper No. 2.
Elkins, P. (ed) (1986) 'Health is Wealth' (various authors) The Living Economy. A New
Economics in the Making, London: Routledge & Keegan Paul 110-127
Enthoven, A. (1991) 'Internal Market Reform of the British National Health Service1,
Health Affairs 10(3) 59-70.
Fry, D. (1991) 'Regionalization... The New South Wales Experience' Sydney: Australian
Community Health Association, Mimeo.
Goodin, R. (1989) No Smoking. The Ethical Issues Chicago: University of Chicago
Press.
Groenwegen, P & McFarlane, B. (1990) A History of Australian Economic Thought,
London: Routledge & Keegan Paul.
Hall, J. & Macguire, A. (1991) 'Health Economics in Australia', Australian Journal of
Public Health, 15(2):78-80.
Harrison, S. (1988) Managing The National Health Service. Shifting the Frontier?
London:Chapman & Hall.
Hart, R.F.G. (1990) 'Inpatient Waiting Lists: The Need for Adequate Data in Australia'
Brisbane: Queensland Department of Health Mimeo.
Harvey, Roy. (1991) Making It Better: Strategies for Improving the Effectiveness and
Quality of Health Services in Australia, National Health Strategy Background Paper No.
8.
Hicks, N. (1978) 'This Sin and Scandal': Australia's Population Debate 1891-1911,
Canberra: ANU Press, Ch.7. 'The Evidence-makers: The Work of Government
Statisticians'.
Hicks, N. (1985) 'Formula Funding and Regional Planning of Health Services in
Australia', [Milbank] Health and Society 63(4) 671-690.
Hicks, N. Furler, E. & Woodward, A. (1982) 'Commentary: Quality Assurance and
Health Care' Community Health Studies, 6(2) 160-166.
Hillier, S.(1987) 'Rationalism, Bureaucracy and the Organisation of Health Services:
Max Weber's contribution to understanding modern health care systems' in G.
Scambler (ed), Sociological Theory of Medical Sociology, London: Tavistock.
Howe, B. & Staples, P.(1991) Rebuilding the Foundations [Budget 1991/92 Portfolio of
Health, Housing and Community Services] Department of Health, Housing and
Community Service.
Jones, Dee et al. (1994) 'Monitoring Changes in Health Services for Older People' in
Robinson & Le Grand, pp. 130-154.
Laffin, M. (1987) 'Politician-Bureaucrat Relationships in Victoria' in Australian Journal of
Public Administration 46(1) 41.
Lawrence, A. (1985) 'Neo-classical economics' in A & J. Kuper (Eds) The Social Science
Encyclopedia London: Routledge & Keegan Paul 554-555.
Leichter, H. M. (1991) Free to be Foolish. Politics and Health Promotion in the United
States and Great Britain Princeton: Princeton University Press.
Light, D. & May, A. eds. (1993) Britain's Health System: From Welfare State to Managed
Markets Washington: Faulkner and Gray.
Lukes, S. (1973) Individualism, Oxford: Blackwell.
Macklin, J (1990). The National Health Stragety: Setting the agenda for Change,
Canberra: National Health Strategy Background paper No.1.
McClelland, Alison, (1991) Spending on Health: The Distribution of Direct Payments
for Health And Medical Services, Canberra: National Health Strategy Background Paper
No. 7.
McGuire, A. Henderson J. & Mooney G. (1988) The Economics of Health Care. An
Introductory Text, London: Routledge & Keegan Paul.
Mills, C. Wright. (1959/1970) The Sociological Imagination, New York:Oxford
University Press/Pelican Books.
New South Wales, Department of Health. (1985) 'The Management and Delivery of
Health Services in New South Wales: An Outline of Corporate Objectives, 1985-1 990'
Sydney: Mimeo. Section 4, 'Managing the Demand for Health Services'.
O'Brien D.P: 'Classical economics' in A & J. Kuper (Eds) The Social Science
Encyclopedia (RKP London 1985) 113-115.
Pusey, M.(1991) Economic Rationalism in Canberra. A Nation-building State Changes
its Mind. Cambridge: Cambridge University Press.
Raphael, D.D. (1989) Adam Smith, Oxford: Oxford University Press
Reich, Robert B.(1988) The Power of Public Ideas, Harvard: Harvard University Press,
introduction and chapters 1-3.
Richardson, J (1991) The Effects of Consumer Co-payments in Medical Care,
Background Paper No.5, Melbourne: National Health Strategy.
Roberts, J.A. (1989) 'The National Health Service: From Myths to Markets' in Health
Policy and Planning 4(1)
Robertson, J. (1985) Health, Wealth and the New Economics, London:The Other
Economic Summit.
Robinson, J.C. (1991) Toil and Toxics. Workplace Struggles and Political Strategies for
Occupational Health Berkeley: University of California Press.
Robinson, R. & LeGrand, J. eds. (1994) Evaluating the National Health Service Reforms
Oxford/New Brunswick, NJ: Policy Journals/Transactions Books
Shaw, G.K. (1985) 'Macroeconomics' in A & J. Kuper (Eds) The Social Science
Encyclopedia, London: Routledge & Keegan Paul.
Solomon, S. (1991) The Australian Health Jigsaw. Integration of Health Delivery
(National Health Strategy Issues Paper No. 1.
Stretton, H. (1974) Housing and Government, Sydney: Australian Broadcasting
Commission 23-27.
Toohey, B. (1994) Tumbling Dice: the story of modern economic policy, Melbourne:
Heinemann Australia.
Victoria, Health Department. (1986) 'HDV-The New Direction' Melbourne: Mimeo.
Weale, Albert (1992) The New Politics of Pollution Manchester: Manchester University
Press, Chapters 5 & 6.
Willcox, Sharon:(1991) A Healthy Risk? Use of Private Insurance National Health
Strategy Background Paper No. 4.
Williams J.C. (1992) Supervised Autonomy: Medical Specialities and Structured Conflict
in an Australian General Hospital Adelaide: University of Adelaide, PhD thesis.
Yeatman, A. (1 987) 'The Concept of Public Management in the Australian State in the
1980s' in Australian Journal of Public Administation, 46(4) 339-353.
eContent Home