Assessing policy transfer from the United States to the British National Health Service

Abstract

Much has been written about the claim that the British National Health Service (NHS) is becoming more like the US health care system, something a number of commentators view as a form of “Americanization”. Yet, that term is imprecise and unhelpful for rigorous analysis of what has, and has not, happened. This paper uses the lens of policy transfer to explore this issue, which provides a sharper insight into policy development. The paper examines the relevance of the Dolowitz and Marsh framework for the study of policy transfer from the US to the British NHS from 1979 onwards. In terms of the framework’s main research questions, the discussion of the potential US influence on the NHS case stresses the role of policy entrepreneurs in policy transfer. In terms of policy success, however, commentators suggest a mix of uninformed, incomplete, or inappropriate transfer. We conclude that Dolowitz and Marsh do provide a useful framework that asks relevant questions about policy transfer, which provides a more nuanced account of policy transfer from the US to the NHS than the crude term “Americanization”.