Managed Care: A Framework for Resource Allocation in the NHS

Abstract

In this article, resource allocation in the NHS is examined from the perspective of US managed care. A distinction is drawn between the roles of payers, commissioners and providers of health care, and the emergence of UK-style ‘health maintenance organisations’ (HMOs) is identified. The key features of US managed care are applied to case study pre-Primary Care Group (PCG) primary care organisations, and the importance of the contracting relationship and of patient choice emerge as issues for resource allocation. This is followed by a checklist of questions for resource allocation in the emerging PCGs and Primary Care Trusts — the true UK ‘HMOs’. The vital role of the Health Authority as system regulator is underlined.