ABSTRACT
Some of the conventional literature on public policy is rather stale and tautologous – and 'technical' rather than political. The assumption of 'rationality as public interest' in policy decisions is that the state is autonomous of class or partial interest. A key concern is the interplay between power, political structure and policymaking. The wider issue is the power of the medical profession, which is slowly declining but still significant in the eyes of many health policy commentators who have seen this as 'the' pivotal power issue in healthcare. Policy initiatives come from politicians in response to politicians' problems, politicians' perception and interpretation of problems and the filtering of problems and perceptions by political advisers, interests and the media. State healthcare systems in Europe have been fragmented in the name of competition and market forces; and 'social insurance' systems have adopted 'managed competition'.
