What drives change in health care systems? Why do certain changes occu r in some nations and not in others? Author Carolyn Hughes Tuohy argue s that the answer lies in understanding the "accidents" of history tha t have shaped national systems at critical moments, and in the distinc tive "logics" of these systems. Tuohy looks at the experiences of Brit ain, Canada, and the US, offering an international comparative study o f public policy systems, as well as a recent history of the circumstan ces in each country that have impacted on the structures of each's nat ional health care system. The guiding focus of the book is Tuohy's stu dy of decision making systems in each country, looking at the decision s made by those who provide, finance, and use health care services. Fi nally, Tuohy reviews current issues in the health care arenas of these three nations and provides suggestions to guide the strategic judgmen ts that decision-makers must make.