ABSTRACT
This chapter begins by looking at the history of policy explanations in the National Health Service, concentrating on four major theoretical perspectives; neo-pluralist, public choice, neo-elitist and neo-Marxist. It examines the development of markets in health care; considering the structure of markets and the extent to which contracts for health services can be based on assessments of needs. The chapter considers the implications of each theoretical perspective for an understanding of health care needs. It examines theories of power in relation to the NHS and highlights the importance of an understanding of the operation of power for analysis of health policy. The chapter outlines the relevance of Habermas’ communicative ethics to the debates concerning power. It sets out how a Habermasian framework can be used as part of an analysis of policy making. The chapter explores the problems that stem from the use of idealised states to criticise and at the same time create a practical state of affairs.
