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Shaping Health PolicyCase Study Methods and Analysis$
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Mark Exworthy, Stephen Peckham, Martin Powell, and Alison Hann

Print publication date: 2011

Print ISBN-13: 9781847427588

Published to Policy Press Scholarship Online: May 2012

DOI: 10.1332/policypress/9781847427588.001.0001

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Repressed interests: explaining why patients and the public have little influence on healthcare policy: Alford's concepts of dominant, challenging and repressed interests

Repressed interests: explaining why patients and the public have little influence on healthcare policy: Alford's concepts of dominant, challenging and repressed interests

Chapter:
(p.119) Eight Repressed interests: explaining why patients and the public have little influence on healthcare policy: Alford's concepts of dominant, challenging and repressed interests
Source:
Shaping Health Policy
Author(s):

Stephen Peckham

Micky Willmott

Publisher:
Policy Press
DOI:10.1332/policypress/9781847427588.003.0008

Robert Alford used a case-study approach to determine why attempts at health care reform in New York in the 1970s often failed to resolve problems in the health system such as rising costs, staff shortages, poor outcomes and poor quality of care (1975, xi). His argument — set out in the book Health Care Politics: Ideological and Interest Group Barriers to Reform — was that embedded structural interests thwarted major reform. Alford identified three types of structural interests: dominant, challenging and repressed. His central argument has three broad elements, the first of which is that bureaucratic and market reforms of health care are likely ultimately to fail. This is due to their general failure to understand how embedded structural interests operate within health care systems. The second is that health policy is affected by an ongoing conflict between dominant and challenging interests. While in his example he shows ‘professional monopolisers’ as the dominant interest and ‘corporate rationalisers’ as the challenging interest, Alford was not prescriptive about this and foresaw that different interest groups may occupy these interests. However, his final point was that the community is normally the repressed interest, and that while both monopolisers and rationalisers may court and collaborate with groups representing these interests, this would be for the benefit of their own interests, too. This appears to be borne out in more recent UK-based studies.

Keywords:   health politics, interest groups, Robert Alford, repressed interest

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