The new Labour government in Britain has issued three variations of a White Paper that outline significant changes in how the world's largest managed care health system will be run. All three emphasize systemwide criteria for quality, effectiveness, and health gain, which in turn imply redressing past inequalities in funding and service. One, the Scottish Paper, eliminates Thatcher's internal market and returns to a simple organizational structure centering on the health boards. The other two propose combining primary care practices into purchasing groups, a daunting task that will spawn many new problems and expenses as it recreates the internal market.
Get full access to this article
View all access options for this article.
References
1.
LightD. W.Medical house arrest. Health Serv. J., November 1, 1990, pp. 1648–1649.
2.
LightD. W.Poor bets on the pools. Health Serv. J., October 16, 1997, p. 22.
3.
PowellM. A.The ghost of health services past: Comparing British health policy of the 1930s with the 1980s and 1990s. Int. J. Health Serv.26: 253–268, 1996.
4.
CaplanR. L.LightD. W., and DanielsN.Benchmarks of fairness: A moral framework for assessing equity. Int. J. Health Serv., 1998, in press.
5.
LightD. W.From managed competition to managed cooperation: Theory and lessons from the British experience. Milbank Q.75: 297–341, 1997.
6.
LightD. W.Homo economicus: Escaping the traps of managed competition. Eur. J. Public Health5: 145–154, 1995.
7.
KarkS. L.Community-oriented Primary Health Care. Appleton-Century-Crofts, New York, 1981.
8.
GeigerH. J.The meaning of community oriented primary care in an American context. In Community Oriented Primary Care—New Directions for Health Services, edited by ConnorE. C. and MullanR.. National Academy Press, Washington, D.C., 1983.
9.
Institute of Medicine.Community-oriented Primary Care: A Practice Assessment, Vols. I and II. National Academy Press, Washington, D.C., 1984.
10.
Secretary of State for Health.The New NHS: Modern, Dependable. HMSO, London, 1997.
11.
LightD.W. Effectiveness and efficiency under competition: The Cochrane test. BMJ303: 1253–1254, 1991.
12.
CochraneA.Effectiveness and Efficiency: Random Reflections on Health Services. Nuffield Provincial Hospitals Trust, London, 1972.
13.
LightD. W.Is NHS purchasing serious? An American perspective. BMJ316: 217–220, 1997.
14.
LightD. W.The restructuring of the American health care system. In Health Politics and Policy, edited by LitmanT. J. and RobbinsL. S., pp. 46–63. Delmar, Albany, N.Y., 1997.
15.
KleinR.The New Politics of the NHS, Ed. 3. Longman, London, 1995.
16.
HaffertyF. W., and LightD. W.Professional dynamics and the changing nature of medical work. J. Health Soc. Behav. (special issue), 1995, pp. 132–153.
17.
HarrisonS.The politics of evidence-based medicine in the United Kingdom. Policy Polit. 26: 15–31, 1998.
18.
HunterD. J., and HarrisonS.Democracy, accountability and consumerism. In Health Choices: Future Options for the NHS, edited by IliffeS. and MunroJ., pp. 120–155. Lawrence & Wishart, London, 1997.
19.
BevanG.Taking equity seriously: A dilemma for government from allocating resources to primary care groups. BMJ315: 112–115, 1998.
20.
SingerR. (ed.). GP Commissioning: An Inevitable Evolution. Radcliffe Medical Press, Abingdon, 1996.
21.
GiddensA.Beyond Left and Right: The Future of Radical Politics. Stanford University Press, Stanford, Calif., 1994.
22.
FryJ.Reviving Primary Care: A US-UK Comparison. Radcliffe Medical Press, Oxford, 1995.
23.
HamC.Public, Private or Community: What Next for the NHS?Demos, London, 1996.
24.
MaysN., and DixonJ.Purchaser Plurality in UK Health Care. King's Fund, London, 1996.
25.
LightD. W.Observations on the NHS reforms: An American perspective. BMJ303: 1253–1254, 1991.
26.
Secretary of State for Scotland.Designed to Care. The Scottish Office, Edinburgh, 1998.
27.
Secretary of State for Wales.NHS Wales: Putting Patients First. The Stationery Office, London, 1998.
28.
DawsonD.Regulating Competition in the NHS. Centre for Health Economics, University of York, York, 1995.
29.
LeGrandJ.Models of Purchasing and Commissioning: Review of the Research Evidence. King's Fund, London, 1997.
30.
Over 75% of GPs want fundholding abolished. Pulse Newsletter survey, January 14, 1995.
31.
PassmanD.A new lease of life for the Private Finance Initiative. Br. J. Health Care Manage. 3(6): 295, 1997.
32.
DawsonD., and MaynardA.Private finance for the public good?BMJ313: 312, 1996.
33.
ApplebyJ.PFI: RIP?Health Serv. J., August 8, 1996, pp. 32–33.
34.
RennS. C.The effects of ownership and system affiliation on the economic performance of hospitals. Inquiry22: 219–236, 1985.
35.
WoolhandlerS., and HimmelsteinD.The mythical efficiency of market medicine: High and rising administrative costs at for-profit hospitals. N. Engl. J. Med.336: 769–774, 1997.
36.
GoodmanA.JohnsonP., and WebbS.Inequality in the UK. Oxford University Press, Oxford, 1997.
