are involved: the consolidation of the tripartite structure into a single unified system, the strengthening of management processes, and the expansion of machinery for making health services more responsive to local needs. While generally supportive of the reorganization, this assessment of the changes in policy and structure identifies a number of constraints in the form of political realities and organizational-administrative capabilities which may limit the attainment of objectives. In particular, the bias in modern medicine for hospital-based specialization, the uneven power relationships among competing professional interests, and the continued separation of health from social services are seen as restricting policy aimed at altering the balance between primary, secondary, and tertiary levels of care and between curative and carative services. Since the pressures underlying the reorganization of the National Health Service (NHS) reflect the broad changes accompanying social and economic development, such as the aging of the population, the shift from acute to chronic patterns of illness, and the decline in the marginal social benefit of capital-intensive medical technology, England's experience may be relevant to other highly developed countries, both as a field laboratory for the elucidation of alternatives and as a case study of the complexities inherent in any attempt to carry out large-scale organizational change. With the possible exception of Sweden's, the reorganization represents the most ambitious attempt to institute comprehensive health services planning and integrated delivery among Western capitalist countries.
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