The health care bureaucracy: small changes, big consequences

Abstract

Administrative changes have been reshaping health policy for the past decade. One consequence is a more constrained medical profession. Another is a more powerful health care bureaucracy. Most industrialized nations have called on democratic principles to balance professional norms; in contrast, Americans are developing a distinctly bureaucratic health care regime. This article suggests why and explores the ramifications for both the politics of health care and the practice of medicine.