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Globalization, Social Capital and Inequality

Contested Concepts, Contested Experiences

Edited by Wilfred Dolfsma and Charlie Dannreuther

This volume investigates the relationship between globalization, inequality and social capital, and reveals that although strongly related, these ideas are also highly contested. The authors elucidate the interactions between these concepts, looking in detail at the conflicts and competitiveness which can arise at both the national and organizational level.
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Chapter 8: The process of market orientation in the UK's National Health Service

Robert McMaster


17307_Globalisation/Chap 8 05/03/2003 9:32 am Page 1 8. The process of market orientation in the UK’s National Health Service Robert McMaster The construal effects of markets arise in large part because people appear to have what might be termed relational preferences: the terms on which they are willing to transact depends both on the perceived relationships among the exchanging parties, and on the related concepts of fairness. Markets affect both. (Bowles, 1998, p. 87) INTRODUCTION The UK’s system of health care, dominated by the National Health Service (NHS), is frequently viewed as a political sacred cow immune from the gale of commercialization that swept through other areas of the UK’s welfare state during the 1980s and 1990s. Far from it. What is more, the UK is far from being unique in this respect, and indeed, the shift towards greater reliance on markets has been seen in some circles as the ‘Great Capitalist Restoration’ (Keaney, 2001), or part of the process of corporate globalization. With respect to this, the chapter employs two central arguments. First, despite the continuity of funding arrangements,1 the NHS has been subject to a period of sustained exposure to market-oriented reforms that culminated in the establishment of a set of institutional arrangements that became infelicitously termed as an ‘internal market’ in 1990. Subsequent legislation has not radically altered the underlying institutional framework, as the use of market-inclined rhetoric indicates. The NHS is no special case in comparison to many other industrialized states (see for...

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