Alford's theoretical political framework and its application to interests in health care now

Abstract

In these troubled times, it can be useful to see whether there are any sociological or political theories that could help us analyse issues from a fresh perspective. Several theories might be relevant but Alford's political theory of interests seems to me especially illuminating. Published in 1975, it is based on Robert R Alford's study of the failure of reforms to improve health care in New York city.1 Its detailed categorisation of interest holders and examination of the political relationships among them, and its general applicability to western healthcare systems, promise to make sense of conflicts of objective and of view in debates about proposed policies and changes in UK health care. Here I outline Alford's theory and look at the convergences and conflicts of interests among the major categories of interest holders he identifies: clinicians, corporate rationalisers, and patients. (Corporate rationalisers is a useful term for bureaucrats, managers, and many academics, see below.) Patients' interests are excluded from discussions about proposed policies more often than other interest holders always realise or intend. Using Alford's framework, I suggest that a more thorough consideration of the interests of all three categories of interest holder could sometimes lead to policies that met the interests of them all. Alford's theory is expressed through the political concepts of interests and power. Interests are difficult to define but roughly mean a stake in something that is important to the interest holder because of the benefit or harm it can do to him or her or to the social group to which he or she belongs.2 Power is ability to bring about significant effects, specifically by furthering the agent's own interests or by affecting the interests of others, whether positively or negatively.2 Values, the worth of something to a person or group, are …