Includes bibliographical references (pages 613-679) and index

Part I: Overview and Theory; 1 Overview; Mis-en-scène; Introduction; The Scale and Pace of Change: Big Bangs, Blueprints, Mosaics, and Increments; Defining the pace of change: Enactment and implementation; Defining the scale of policy change: Influence, instruments, organizing principles, and logics; Four strategy types; four strategic domains; The Evolving Agenda of Welfare-State Politics and the Case of Health Care; Phases of welfare-state politics; The case of health care policy: The agenda of market-oriented redesign

The Politics of Scale and Pace in Health Care ReformImplementation and the Role of Institutional Entrepreneurs; 2 Defining the Scale and Pace of Policy Change; Elements of Scale: Influence, Instruments, Principles, and Policy Logics; The balance of influence: The state, private finance, and providers; The mix of instruments: Hierarchy, exchange, and peer control; Organizing principles: The basis of entitlement and the functional role of the state; Policy logics: The intersection of influence, instruments, and principles; Transforming the logics of health care policy: Four nations

The Pace of Policy Change: Historical and Strategic PerspectivesTiming as history: Continuous and discontinuous change; Timing as strategy: Pace as a strategic choice; Bringing Scale and Pace Together: A Simplified Decision Tree; Part II: The Founding and Evolution of the Health Care State to the 1980s; 3 The Establishment and Evolution of the British and US Health Care States to the 1980s; Britain: The Big Bang of the NHS; The window: A landslide election and a sweeping agenda; The strategy: An appointed date for a new institution; The United States: Medicare/Medicaid Mosaic

The precursor: The big bang of Social SecurityThe window: A landslide election and a broad social policy agenda; Policy Cycling in the 1970s and 1980s; Britain: Centralization/decentralization; integration/independence; professionalism/managerialism; The United States: Regulation versus deregulation; largesse versus constraint; Conclusion; 4 The Establishment and Evolution of the Dutch and Canadian Health Care States to the 1980s; The Netherlands: Consensus, Corporatism, and Coalition Governments under Stress; Solidarity, subsidiarity, and the "social middle ground"

The Dutch health care state as of the 1970sCanada: Regionalism, Federalism, and the Scope and Limits of the "Sharing Community"; Regional differences and coping mechanisms; The evolving institutions, agenda, and tone of intergovernmental relations; Health care in the evolving federation; Establishing the Canadian health care state: The warm-up -- universal hospital insurance; Establishing the Canadian health care state: The main event -- universal physician services insurance; Denouement: "Paradigm freeze" and policy cycling; Conclusion

"One of the most persistent puzzles in comparative public policy concerns the conditions under which discontinuous policy change occurs. In Remaking Policy, Carolyn Hughes Tuohy advances an ambitious new approach to understanding the relationship between political context and policy change. Focusing on health care policy, Tuohy argues for a more nuanced conception of the dynamics of policy change, one that makes two key distinctions regarding the opportunities for change and the magnitude of such changes. Four possible strategies emerge: large-scale and fast-paced ("big bang"), large-scale and slow-paced ("blueprint"), small-scale and rapid ("mosaic"), and small-scale and gradual ("incremental"). As Tuohy demonstrates, these strategies are determined not by conditions themselves, but by the ways in which political actors, individually and collectively, assess their prospects for success in the present and over time. Drawing on interviews as well as primary and secondary accounts of ten cases of major change in health policy over seven decades (1945-2015) in the US, UK, the Netherlands, and Canada, Remaking Policy represents a bold step toward understanding the scale and pace of change in health policy and beyond."--