Convergence or divergence? Reforming primary care in Norway and Britain

Many countries are currently reorganizing their health services in response to cultural, economic, and technological changes. Because the changes are global, different countries are drawn toward similar reform programs. But countries' cultural, economic, and political differences also may lead to divergent responses. This article examines the convergence thesis by comparing recent changes in primary care in Norway and Britain. There seems to be a convergence in objectives, a divergence in remuneration systems, and both divergence and convergence in organizational structures. To understand the dynamics of change, divergence is discussed in relation to the social context of the political initiatives. Divergences are explained by economic, political, and cultural differences, as well as differences in physicians' political power and density.