Britain's National Health Service (NHS) has been the subject of unprecedented market reforms, which have failed to solve its problems. The New Labour government elected in 1997 has halted the drive toward the marketization of health care and replaced cost with quality as the central concern of NHS administration and policy. Major changes are occurring in the regulation of professional activity, with profound implications for the medical profession and the health service. The authors discuss these changes and possible future problems for the NHS.
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References
1.
FreemanR., Competition in context: The politics of health care reform in Europe. Int. J. Qual. Health Care10(5): 395–401, 1998.
2.
FierlbeckK., Policy and ideology: The politics of post-reform health policy in the United Kingdom. Int. J. Health Serv. 26(3): 529–546, 1996.
3.
Renewing the National Health Service: Labour's agenda for a healthier Britain.Int. J. Health Serv. 26(2): 269–308, 1996.
4.
KleinR., Why Britain is reorganising its National Health Service—yet again. Health Aff. 18(2): 261–262, 1999.
5.
FisherP., The reform of the reform of the British National Health Service. J. Public Health Policy20(20): 138–148, 1999.
6.
GoddardM., and MannionR., From competition to co-operation: New economic relationships in the National Health Service. Health Econ. 7(2): 105–119, 1998.
7.
Department of Health, Welsh Office, Scottish Home and Health Department, and Northern Ireland Office.Working for Patients. Cm. 555. HMSO, London, 1989.
8.
ButlerJ.Origins and early development. In Evaluating the NHS Reforms. King's Fund Institute, London, 1994.
9.
MaynardA., Competition and quality: Rhetoric and reality. Int. J. Qual. Health Care10(5): 379–384, 1998.
10.
QuamL., Improving clinical effectiveness in the NHS: An alternative to the white paper. BMJ299: 448–450, 1989.
11.
MullenP.Health and the Internal Market: Implications of the White Paper. Discussion Paper No. 25. University of Birmingham Health Services Management Centre, Birmingham, 1989.
12.
DawsonD.Costs and Prices in the Internal Market: Markets vs the NHS Management Executive Guidelines. Centre for Health Economics Discussion Paper No. 115. University of York, York, 1994.
13.
GlennesterH., Competition and quality in health care: The UK experience. Int. J. Qual. Health Care10(5): 403–410, 1998.
14.
Le GrandJ., Competition, co-operation or control? Tales from the British National Health Service. Health Aff. 18(3): 27–39, 1999.
15.
TuohyC. H., Dynamics of a changing health sphere: The United States, Britain and Canada. Health Aff. 18(3): 114–134, 1999.
16.
PropperC., and SoderlundN., Competition in the NHS internal market: An overview of its effects on hospital prices and costs. Health Econ. 7(3): 187–197, 1998.
17.
DrummondM.CookJ., and WalleyT., Economic evaluation under managed competition: Evidence from the UK. Soc. Sci. Med.45(4): 583–595, 1997.
18.
Le GrandJ., Internal market rules UK. BMJ309: 1596–1597, 1994.
19.
RobinsonR., and Le GrandJ.Contracting and the purchaser-provider split. In Implementing Planned Markets in Health Care: Balancing Social and Economic Responsibility, edited by SaltmanR. B. and von OtterC.. Open University press, Buckingham, 1995.
20.
PatonC.Firm control. Health Serv. J. August 6, 1992, pp. 20–22.
21.
JenkinsS.Accountable to None: The Tory Nationalisation of Britain. Hamish Hamilton, London, 1995.
22.
DorrellS.NHS reforms. House of Commons Official Report (Hansard)200, no. 27, Col. 245, December 6, 1991.
23.
PetcheyR., NHS internal market 1991–2: Towards a balance sheet. BMJ306: 699–701, 1993.
24.
National Health Service Consultants Association.In Practice: The NHS Market. Banbury, 1994.
25.
KoperskiM., and RodnickJ. E., Recent developments in primary care in the United Kingdom: From competition to community-oriented primary care. J. Fam. Pract.48(2): 140–145, 1999.
26.
SmithR. D., and WiltonP., General practice fundholding: Progress to date. Br. J. Gen. Pract.48(430): 1253–1257, 1998.
27.
HoughtonK., Peak practices. Health Serv. J.103: 26–27, 1993.
28.
GlennersterH.OwensP., and MatsaganisM.A Foothold for Fundholding. King's Fund Institute, London, 1992.
29.
BradlowJ., and CoulterA., Effect of fundholding and indicative prescribing schemes on general practitioners' prescribing costs. BMJ307: 1186–1189, 1993.
30.
MaxwellM., General practice fundholding: Observations on prescribing patterns and costs using the defined daily dose method. BMJ307: 1190–1194, 1993.
31.
Teeling-SmithG.The economics of prescribing and under-prescribing. In Medicines: Responsible Prescribing, edited by WellsF. O.. Queens University, Belfast, 1992.
32.
PetcheyR., General practitioner fundholding: Weighing the evidence. Lancet346: 1139–1142, 1995.
33.
DaviesJ., How much does the scheme cost?Fundholding4(2): 22–24, 1995.
34.
MorrisR., and ArmstrongM., Do not overestimate the scheme's costs. Fundholding4(4): 13, 1995.
35.
FreudensteinU., Fundholding from the inside. Med. World.13: 10–11, 1993.
36.
WilliamsG.FlynnR., and PickardS., Paradoxes of GP fundholding: Contracting for community health services in the British National Health Service. Soc. Sci. Med.45(11): 1669–1678, 1997.
37.
CorneyR. H., and KerrisonS., Fundholding in South Thames Region. Br. J. Gen. Pract.47(422): 553–556, 1997.
38.
BosanquetN., and LeeseB.Family Doctors and Economic Incentives. Aldershot, Dartmouth, 1989.
39.
MaynardA. Unpublished discussion paper.
40.
SmithR., Words from the source: An interview with Alain Enthoven. BMJ298: 1166–1168, 1989.
41.
WillisA.Who needs fundholding?Health Serv. J., April 30, 1992, pp. 24–25.
42.
Department of Health. Statistical Bulletin 1994/11. HMSO, London, 1994.
43.
ApplebyJ.Managers: In the ascendancy?Health Serv. J., September 21, 1995, pp. 32–33.
44.
LightD. W., Homo economicus: Escaping the traps of managed competition. Eur. J. Public Health5: 145–154, 1995.
45.
National Health Service Management Executive.The NHS Reforms: The First Six Months. Department of Health, London, 1992.
46.
KleinR., NHS reforms: The first six months. BMJ304: 199–200, 1992.
47.
Radical Statistics Health Group.NHS Reforms: The First Six Months—Proof of progress or a statistical smokescreen?BMJ304: 705–709, 1992.
48.
Radical Statistics Health Group.NHS ‘indicators of success’: What do they tell us?BMJ310: 1045–1050, 1995.
49.
National Consumer Council. Consumer Concerns 1993: A Consumer View of Health Services—The Report of the MORI Poll. London, 1993.
50.
SpiersJ.The Invisible Hospital and the Secret Garden. Radcliffe Medical Press, Oxford, 1995.
51.
HarrisonS., and LachmannP. J.Towards a High Trust NHS: Proposals for Minimally Invasive Reform. Institute for Public Policy Research, London, 1996.
52.
GoldacreM. J.LambertT. W., and ParkhouseJ., Views of doctors in the United Kingdom about their professional position and the National Health Service reforms. J. Pubic Health Med. 20(1): 86–92, 1998.
53.
PerkinsR. J., Health service reforms: Perceptions of medical specialists in Australia, the United Kingdom and New Zealand. Med. J. Aust.167(4): 201–204, 1997.
54.
LoewenbergJ. J., Industrial relations effects of English health care reforms on doctors. Int. J. Health Serv. 26(4): 611–623, 1996.
55.
Harrison, S. From here to perversity.Health Matters7, 1991.
56.
Gain without pain.Health Serv. J., January 30, 1992.
57.
ClarkeA., and McKeeM., The consultant episode: An unhelpful measure. BMJ305: 1307–1308, 1992.
58.
MunroJ., Why health economists are economical with the truth. Health Care Anal. 1(2): 197–199, 1993.
59.
PollockA. M., The NHS goes private. Lancet346: 683–684, 1995.
60.
WhitfieldD.The private finance initiative. Health Matters24, Winter 1996.
61.
PollockA. M., The creeping privatisation of community care. Health Matters20: 9–11, Winter 1994.
62.
MunroJ.Post-modern medicine. Med. World., Autumn 1990, pp. 20–21.
63.
HarrisonS., and PollittC.Controlling Health Professionals: The Future of Work and Organisation in the NHS. Open University Press, Buckingham, 1994.
64.
WebsterC., New Labour promises but old Tory policies. Health Matters38: 5, 1999.
65.
Secretary of State for Health. The New NHS: Modern, Dependable. The Stationery Office, London, 1997.
66.
IliffeS., and MunroJ., Do general practitioners respond to incentives. BMJ307: 1156–1157, 1993.
67.
Department of Health.Health Service Circular 1998/230: Governing Arrangements for Primary Care Groups. London, 1998.
68.
Department of Health.Health Service Circular 1998/190: PCG Remuneration. London, 1998.
69.
Department of Health.Health Service Circular 1998/198: Commissioning Services 1999–2000. London, 1998.
70.
Department of Health. Health Service Circular 1998/228: Primary Care Groups: Delivering the Agenda. London, 1998.
71.
MunroJ.Evaluation of NHS Direct: First Interim Report to the Department of Health. Medical Care Research Unit, Sheffield, 1999.
72.
KleinR., and MaynardA., On the way to Calvary. BMJ317: 5, 1998.
73.
ChappelD., Models of commissioning health services in the British National Health Service: A literature review. J. Public Health Med. 21(2): 221–227, 1999.
74.
EavesD., An examination of the concept of equity and the implications for health policy if equity is re-asserted as one of the key government objectives for the National Health Service. J. Nurs. Manage.6(4): 215–221, 1998.
75.
BlaugM.Where are we now in British health economics?Health Econ. (Suppl. 1): S63–78, 1998.
76.
BlendonR. J., Satisfaction with health systems in 10 nations. Health Aff. 9: 185–192, 1990.
77.
DonellanK., The cost of health system change: Public discontent in five nations. Health Aff. 18(3): 206–216, 1999.
78.
MaysN., and KeenJ., Will the fudge on equity sustain the NHS into the next millennium?BMJ317: 66–69, 1998.