Restructuring Patterns of Elite Dominance and the Formation of State Policy in Health Care

The authors analyze recent state intervention to control health care costs as both reflecting and fostering changes in previously prevailing patterns of dominance among health care elites and between those elites and nonhealth elites. The authors contend that these health policy outcomes reflect a divergence of material interests and a political fragmentation among dominant health elites and between those and nonhealth, especially corporate, elites, which previously allowed health provider elites to control the health policy agenda. Empirical analysis shows that patterns of fragmentation among hospital elites and cohesion among business elites, in the form of business coalition development, can account for the adoption/retention of the four predominant state health care cost containment policies during the period 1981-87. The authors conclude that a political and economic restructuring of elite dominance is taking place but it is occurring unevenly across states and regions.