Understanding NHS Reform: The Policy-Transfer, Social Learning, and Path-Dependency Perspectives



This paper utilizes three perspectives in analyzing health policy in the U.K. during the formulation of the “internal market” reforms of the late 1980s and early 1990s: policy transfer, social learning, and path-dependency. By doing so, it attempts to incorporate the most significant insights from each perspective to construct a framework for analysis that better illuminates the actors, processes, and constraints involved in health policy reform, as well as providing a means of assessing its importance. I suggest that the reform process in the U.K. was considerably more complex than most existing accounts suggest, and that notions such as “conjuncture” require caution in their usage in order to avoid confusion between the contingent and relatively permanent factors that allow reform to occur.