Academic journal article Health Sociology Review

Global Challenges, Global Solutions? A Cross-National Comparison of Primary Health Care in Britain, Norway and the Czech Republic

Academic journal article Health Sociology Review

Global Challenges, Global Solutions? A Cross-National Comparison of Primary Health Care in Britain, Norway and the Czech Republic

Article excerpt


Western welfare states are facing new challenges in their efforts to ensure universal access to affordable, high-quality health services. The new challenges are tied to cultural, economic, political, medical and demographic changes such as medicalisation, heightened public expectations, new medical knowledge and technology, ageing populations, escalating costs and an increasing gap between demand and supply. As a response to this new situation, all western industrialised countries are currently changing the way their health services are funded and organised. The dominant theory is that because all countries face the same challenges, and because they are all exposed to a worldwide process of globalisation, different countries are heading in the same direction with similar reform programs. An alternative hypothesis is that each country has unique cultural, economic, political and historical traditions that are likely to override global impulses and create patterns of divergence.

In this article, I discuss theories of globalisation and convergence in tandem with a cross-national comparison of changes in primary health care1 between 1990 and 2005 in three European countries: Britain, Norway and the Czech Republic. To limit the field of research, I focus on the services of general practitioners (GPs). The main question is: in what ways and to what degree has convergence and divergence occurred? Recent changes in how GP services are organised in each country are described, compared and explained. Finally, I discuss what implications these findings have for theories of health policy formation.

Globalisation and convergence

The analysis is underpinned by theories about convergence versus divergence among nations. These theories relate to sources of social change (global or local), as well as how these sources affect the development of different societies (the degree of convergence or divergence). Both of these two aspects concern theories of globalisation.

Impulses of social change: Global or local?

Globalisation is referred to as the central concept by which we understand current social development in the western industrialised world. In its widest meaning, the concept means 'to make global'. It is commonly used to describe the increasing global interconnectedness of humanity in nearly all spheres of human endeavour (Harris and Seid 2004). Waters (2001) defines globalisation as a social process in which the global influence on economic, political, social and cultural arrangements increases at the expense of local influence.2 When the global influence increases, the end result is a cultural homogeneity that makes the world an increasingly unified place: 'In a globalized world there will be a single society and culture occupying the planet' (Waters 2001:5). Two key elements in this definition are increasing global influence and increasing similarity. The idea here is that because local developments are influenced by global conditions, differences diminish and similarities grow.

Theories of globalisation, and especially its cultural dimension, are disputed by scholars working on a theory of cultural diversity. According to this theory, local factors are expected to override global factors in social development:

Different societies follow different trajectories, even when they are subjected to the same forces of economic development, because situation-specific factors, such as society's cultural heritage, also shape how a particular society develops (Inglehart 2006:123).

There are various arguments given for this general theory. Cohen (1985) proposes that instead of cultural homogeneity, globalisation might lead to a revitalisation of those features which distinguish one community from another. The reason for this, is that their members perceive the global impulses as a threat to their local culture:

... the greater the pressure on communities to modify their structural forms to comply more with those elsewhere, the more are they inclined to reassert their boundaries symbolically (Cohen 1985:44). …

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