Health care reform has become one of the most prevalent topics in recent policy discourse within and across nations. In the 1990s, common features of the health care arena elevated the importance of bargaining relationships among large, sophisticated entities as the dominant mode of decision-making, fundamentally challenging the traditional dominance of the medical profession, which had been grounded in individualized "agency" relationships between providers and patients. These developments have played out in varying ways around the globe. Carolyn Hughes Tuohy looks at the experiences of the United States, Britain, and Canada, offering an international comparative study of public policy systems, as well as a recent history of the evolution of each national health care system. L What drives change in health care systems? Why do certain changes occur in some nations and not in others? Tuohy argues that the answer lies in understanding the "accidents" of history that have shaped national systems at critical moments and in the distinctive "logics" of these systems. Her study carefully delineates both the common logic of the health care arena, deriving from micro-economic characteristics and technological change, and the particular logics of national systems, put in place by specific episodes of policy change. She goes on to explore how in the wake of these episodes, the mixed market in the United States, hierarchical corporatism in Britain, and the single-payer system in Canada determined the subsequent direction and pace of change in all three countries. Finally, Tuohy provides suggestions to guide the strategic judgments that decision-makers must make within the health care system of each country. Accidental Logics uniquely departs from the descriptive literature currently available by presenting an extensive review of the evidence regarding the evolution of the health care arenas in the United States, Britain, and Canada, integrated within an explanatory framework. It is essential up-to-date reading for political scientists working in comparative politics and public policy, health policy analysts, government agency officials, and students in political science, health policy, and administration programs.

Cross-national discourse in public policy is marked by an ongoing tension between the common and the particular. At one extreme, we identify common trends and challenges in a given policy arena, and view national systems as laboratories in which responses to these challenges can be tested and, if successful, emulated. At the other extreme, we see national systems as so idiosyncratic that only "home-grown" solutions are possible.

In the health care arena of the 1990s, this tension was clearly apparent. On the one hand, cross-national attention was drawn to the alleged potential of market mechanisms to squeeze greater efficiency from health care delivery systems, as both public and private payers became more cost- and price-conscious. Experiments in Britain, the Netherlands, New Zealand, Sweden, and elsewhere, themselves influenced by developments in the United States, were closely watched for their lessons for other nations. At the same time, national debates about health care reform, particularly in the United States but also in other nations, were marked as well by skepticism about the applicability of foreign models to domestic circumstances.

Like policy makers, students of comparative public policy also debate the relative importance of common or distinctive features of national policy arenas. Countless conferences and symposia have been devoted to the question of whether advanced capitalism is driving toward a common model in economic . . .