Towards a new pluralism.

The thesis of this paper is that the future development of health services, cross-nationally, is likely to be influenced more by changes in organisational, managerial and information technologies than by ideological preferences. Such changes are likely to make the traditional ideological and conceptual distinction between the public and private sector redundant, as boundaries become blurred. The trend, it is argued, is towards forms of organisations based on networks rather than hierarchies and towards for-profit or co-operative health care enterprises complementing large-scale public organisations. Such forms of health care organisation, it is further argued, are likely to promote adaptability in the face of rapid change and satisfy producer demands for autonomy. The thesis is illustrated by the recent experience of Britain where more flexible organisational patterns are emerging which, however, do not comfortably fit into the traditional public/private conceptual antithesis despite the ideological bias of the Conservative Government towards market solutions. Finally, the paper concludes that American ideas and experience may be a poor guide for European countries, since change starts from a very different organisational and intellectual foundation.