Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case?

Ettelt, S; Mays, N; Chevreul, K; Nikolentzos, A; Thomson, S; Nolte, E; (2010) Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case? Social policy & administration, 44 (3). pp. 225-243. ISSN 0144-5596 DOI:

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This article examines the involvement of ministries of health in making health service coverage decisions in Denmark, England, France and Germany. The study aims to inform debate in England about the feasibility of reducing perceived ministerial and bureaucratic 'interference' in decisions affecting the National Health Service, based on interviews with senior government officials and other health system stakeholders. Ministries of health differ in their involvement in health system governance and coverage decisions ('the benefits package'), reflecting differences in institutional arrangements. In all four countries, organizations at arm's length or independent from government are either involved in providing technical advice to the ministry of health or have been mandated to take these decisions themselves. However, ministries of health occasionally intervene in the decision-making process or ignore the advice of these organizations. The Department of Health in England is not an aberrant case, at least in relation to coverage decisions. Indeed, ministries of health in Denmark and France play a larger role in making these decisions. Public pressure, often amplified by the media, is a shared reason for ministerial and ministry involvement in all four countries. This dynamic may thus limit the feasibility of attempts to further separate the NHS from both the Department of Health and wider political pressures.

Item Type: Article
Keywords: Ministries of health, Governance, Decision-making, Health service, coverage, Benefits package, New Public Management, public management, care
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Web of Science ID: 277419700001


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