ABSTRACT
Health care policy, it is argued in this chapter, is an essential ingredient of community care, but the policy decisions have been shackled by traditional organisational divisions between health and social care. Again, health policies reflect the ideological perspectives of government, and, in this respect, the substantial changes effected in health policy and administration during the 1980s and 1990s not only represent responses to demographic and social developments in the society, but also much broader ideological strategies in social policy per se, whereby collectivism gives way to individualism; public needs cede to managerialism and the market; and equity gives way to cost effectiveness and income generation. Yet such tendencies constitute part of the ‘paradigm’ shift occurring in a number of other countries where the burgeoning cost of health is posing a multitude of policy problems. The particular solutions being offered vary to an extent, but they are also clearly related to social and community care strategies - hence the great significance attached to the means for effective collaboration between health and social care agencies. In many cases, organisational cultures constitute the barrier; traditional professional hegemony and power are at stake, particularly between the medical profession and the allied ‘caring’ professions.
