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Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case?
Author(s) -
Ettelt Stefanie,
Mays Nicholas,
Chevreul Karine,
Nikolentzos Athanasios,
Thomson Sarah,
Nolte Ellen
Publication year - 2010
Publication title -
social policy and administration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.972
H-Index - 63
eISSN - 1467-9515
pISSN - 0144-5596
DOI - 10.1111/j.1467-9515.2010.00710.x
Subject(s) - government (linguistics) , bureaucracy , public administration , public relations , public health , corporate governance , politics , christian ministry , health policy , health services , service (business) , political science , business , medicine , nursing , environmental health , population , law , marketing , philosophy , linguistics , finance
This article examines the involvement of ministries of health in making health service coverage decisions in Denmark, England, France and Germany. The study aims to inform debate in England about the feasibility of reducing perceived ministerial and bureaucratic ‘interference’ in decisions affecting the National Health Service, based on interviews with senior government officials and other health system stakeholders. Ministries of health differ in their involvement in health system governance and coverage decisions (‘the benefits package’), reflecting differences in institutional arrangements. In all four countries, organizations at arm's length or independent from government are either involved in providing technical advice to the ministry of health or have been mandated to take these decisions themselves. However, ministries of health occasionally intervene in the decision‐making process or ignore the advice of these organizations. The Department of Health in England is not an aberrant case, at least in relation to coverage decisions. Indeed, ministries of health in Denmark and France play a larger role in making these decisions. Public pressure, often amplified by the media, is a shared reason for ministerial and ministry involvement in all four countries. This dynamic may thus limit the feasibility of attempts to further separate the NHS from both the Department of Health and wider political pressures.