Le changement dirigé par le haut au Royaume-Uni: un point de vue politique

This article analyzes the British experience of healthcare reform to underscore the difficulties and risks inherent in major, government-imposed reforms. Indeed, the British health system underwent a series of radical reforms that began in 1979 and continue today and that have ranged from the "internal market" implemented by the Thatcher government, to the "modernization" agenda imposed by the current Labour government. All of these major reforms reflect, on the one hand, an evolution of political ideologies and, on the other hand, the power of the central government to impose major transformations of structures and incentives. While such major structural transformations certainly produce results, they are not necessarily those targeted in terms of patient empowerment and quality of care. Interpretative schemes and practices do not change at the same pace as structures. Moreover, these continuous upheavals themselves generate high transaction costs