Health care needs and health policy : the case of renal services.
Abstract
This thesis presents a critical ethnography of decision making with respect to the
assessment of health care needs in the UK health system. Theories of need, justice
and rights are reviewed in relation to structural changes to the National Health
Service, together with the different theoretical approaches underpinning health
policy based on human needs. The research on which this thesis is based focuses on
a case study of an independent review of renal services in London, concentrating on
the needs assessment work of the review group set up by the government and the
decision making debates this review group engaged in. The methods used are based
on a participatory, critical ethnography. The review process is evaluated critically
by relating the technical knowledge produced by the group to a theoretical
framework for assessing needs and by using a Habermasian perspective to
investigate the ways in which the language of need is used to legitimise the agendas
of various vested interests. This work is linked with an analysis of quasi-markets
in the health service to explore the capacity that the technical discourses of markets
and contracting have for reinforcing the ideological distortions identified in the
analysis of the group's debates concerning need. Finally, by linking an analysis
based on a case study of renal services to theoretical understandings of health care
needs and health policy, a general critique of the UK health system is constructed.
Authors
Jones, Ian ReesCollections
- Theses [3706]