Can competition enhance efficiency in health care? Lessons from the reform of the U.K. National Health Service
AbstractSince 1991 the reform of the U.K.-NHS has been introduced cumulatively. Public funding of health care has been retained and the goal of the reformers is to improve the efficiency of resource allocation by creating competition on the supply side of the market. The introduction of more autonomous Trust hospitals, general practice fund holders (GPFH) and the purchaser-provider divide is described. The policy contradictions in the implementation of the reforms are analyzed: the incomplete utilization of population weighted funding, the absence of a strategy in the development of GPFHs which are at once the mavericks and the catalysts of change in the new structures, the poor articulation of pricing and contracting rules, the maintenance of planned labour and capital markets which facilitate cost control but frustrate resource reallocation, and the incomplete articulation of many market rules (e.g. about merger and exit). It seems that the rhetoric of the market has been submerged in legislation and managerial rules which increase the power of central government rather than delegating control to local providers and purchasers. The lessons of the U.K. reforms for future innovators in the design of health care systems are numerous. Would a new Hippocratic Oath requiring the delivery by professionals of knowledge based medicine be as efficient but have lower transactions costs than the creation of an internal market? Who should regulate the health care market and how? How can reform best be sequenced? Is reform of funding (competing purchasers) an essential ingredient in the reform process or will supply side reform alone be adequate? The price of knowledge is high but the cost of ignorance is greater: how can cost effectiveness data be produced and disseminated best to change behaviours? Should not all reform processes be evaluated? The British choose to avoid evaluation and as a consequence the lessons of the reforms are very difficult to quantify. Whilst the U.K.-NHS reforms created a lot of enthusiasm and energy its effects are difficult to disentangle from the simultaneous increases in funding and managerial reforms which began in 1983. There is little evidence from the U.K. or elsewhere that competition in health care produces improvements in resource allocation. There is the risk that such processes may undermine cost sontrol through erosion of single payer constraints and quality competition. The scope for improving resource allocation is considerable but competition like other unevaluated reform proposals, needs to be used with caution and recognised as a means and not an end in itself.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.
Bibliographic InfoArticle provided by Elsevier in its journal Social Science & Medicine.
Volume (Year): 39 (1994)
Issue (Month): 10 (November)
Contact details of provider:
Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description
You can help add them by filling out this form.
CitEc Project, subscribe to its RSS feed for this item.
- Anell, Anders, 1996. "The monopolistic integrated model and health care reform: the Swedish experience," Health Policy, Elsevier, vol. 37(1), pages 19-33, July.
- Xu, Weiwei & van de Ven, Wynand P.M.M., 2009. "Purchasing health care in China: Competing or non-competing third-party purchasers?," Health Policy, Elsevier, vol. 92(2-3), pages 305-312, October.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Wendy Shamier).
If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.
If references are entirely missing, you can add them using this form.
If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.
If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.
Please note that corrections may take a couple of weeks to filter through the various RePEc services.