ABSTRACT
Management everywhere in health care is political in the fundamental sense of involving decisions about who gets what and a continuing debate about the values that ought to shape its activities. Management in health care is likely to he, increasingly, an exercise in the control over the diffusion of innovation. Systematic evaluation is the necessary counterpart to spontaneous experiment: the screening of innovations before permitting their general adoption. The significance of value conflicts, or, to put it another way, the justifying ideologies of the different, competing interest groups represented in the health care policy arena, is equally apparent when we look at the other side of the coin of innovation, that of policy termination. The health care ‘market’ is different not only because of the very pronounced imbalance of knowledge and expertise between producers and consumers: no-one has yet been able to produce a Michelin guide to hospitals, far less a consumer guide to individual medical practitioners or procedures.
