Using a variety of evidence in the health management field, the
author documents the rise of general management, the application of
new techniques to reduce medical costs and improve efficiency, and
other methods of controlling, using and evaluating clinical
performance. The impact and significance of these developments is
discussed and illustrated in detail by means of original case study
material and interview data about managerial strategies of
rationalization and retrenchment. Rob Flynn describes new systems
of monitoring, regulation and surveillance applied to doctors and
health workers, and argues that these threaten established power
relations and institutional arrangements, by elevating managerial
concepts for efficiency above professional definitions of need and
citizenship demands for unrestricted access on the basis of need.
Measures to create an internal market in the NHS are also analyzed,
and the author argues that current trends will intensify managerial
influence and undermine professional medical power. The
contradictions and complexities of changes in structures of control
in the NHS are examined in connection with critical assessments of
theories about state rest
General
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