IDEAS home Printed from https://ideas.repec.org/a/sae/envirc/v16y1998i4p449-462.html
   My bibliography  Save this article

Localism in the NHS Quasi-Market

Author

Listed:
  • M Exworthy

    (Institute for Health Policy Studies, University of Southampton, Southampton SO17 1BJ, England)

Abstract

The organisation of the British National Health Service (NHS) has been hierarchical and based on defined geographical areas [for example, health authorities (HAs)]. These areas have formed the basis of local health systems in which the social relations between individuals and agencies were contained within the territorial boundaries of the respective organisation and thereby engendered, in most eases, a degree of trust and cooperation. The introduction of quasi-market mechanisms in the NHS in 1991 inferred that the social relations between local actors were not essential and hence transactions could be independent of them. Economic transactions need not therefore be confined to the local area. However, social relations have continued in various forms since the quasi-market was implemented as manifested through, inter alia, the persistence of localism in the market. Localism is evident, for example, in HA expenditure, which remains highly skewed towards local providers and, it is argued here, is a function of social relations between purchaser and providers. Localism and the social relations associated with it exemplify the relational nature of the quasi-market, which has shown signs of moves towards longer term contracts, risk-sharing and cooperation (rather than competition). Thus, by noting the persistence of localism and social relations, the author suggests that the quasi-market has yet to evince the paradigm shift intended by the 1991 reforms.

Suggested Citation

  • M Exworthy, 1998. "Localism in the NHS Quasi-Market," Environment and Planning C, , vol. 16(4), pages 449-462, August.
    • Handle: RePEc:sae:envirc:v:16:y:1998:i:4:p:449-462
    DOI: 10.1068/c160449
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1068/c160449
    Download Restriction: no
    File URL: https://libkey.io/10.1068/c160449?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Dranove, David & Shanley, Mark & White, William D, 1993. "Price and Concentration in Hospital Markets: The Switch from Patient-Driven to Payer-Driven Competition," Journal of Law and Economics, University of Chicago Press, vol. 36(1), pages 179-204, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Jones, Lorelei & Exworthy, Mark & Frosini, Francesca, 2013. "Implementing market-based reforms in the English NHS: Bureaucratic coping strategies and social embeddedness," Health Policy, Elsevier, vol. 111(1), pages 52-59.
    2. Exworthy, Mark & Frosini, Francesca, 2008. "Room for manoeuvre?: Explaining local autonomy in the English National Health Service," Health Policy, Elsevier, vol. 86(2-3), pages 204-212, May.
    3. Castelli, Adriana & Jacobs, Rowena & Goddard, Maria & Smith, Peter C., 2013. "Health, policy and geography: Insights from a multi-level modelling approach," Social Science & Medicine, Elsevier, vol. 92(C), pages 61-73.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pan, Jay & Qin, Xuezheng & Li, Qian & Messina, Joseph P. & Delamater, Paul L., 2015. "Does hospital competition improve health care delivery in China?," China Economic Review, Elsevier, vol. 33(C), pages 179-199.
    2. Boutsioli, Zoe, 2007. "Concentration in the Greek private hospital sector: A descriptive analysis," Health Policy, Elsevier, vol. 82(2), pages 212-225, July.
    3. Eulàlia Dalmau & Jaume Puig, 1997. "Market structure and hospital efficiency: Evaluating potential effects of deregulation in a national health service," Economics Working Papers 214, Department of Economics and Business, Universitat Pompeu Fabra.
    4. Berden, Carolien & Croes, R. & Kemp, R. & Mikkers, Misja & van der Noll, Rob & Shestalova, V. & Svitak, Jan, 2019. "Hospital Competition in the Netherlands : An Empirical Investigation," Discussion Paper 2019-008, Tilburg University, Tilburg Law and Economic Center.
    5. Ethan M. J. Lieber, 2017. "Does It Pay to Know Prices in Health Care?," American Economic Journal: Economic Policy, American Economic Association, vol. 9(1), pages 154-179, February.
    6. Boone, J. & Douven, R.C.M.H., 2014. "Provider Competition and Over-Utilization in Health Care," Discussion Paper 2014-055, Tilburg University, Center for Economic Research.
    7. Jean Marie Abraham & Martin Gaynor & William B. Vogt, 2007. "Entry And Competition In Local Hospital Markets," Journal of Industrial Economics, Wiley Blackwell, vol. 55(2), pages 265-288, June.
    8. Jan Boone & Rudy Douven, 2014. "Provider competition and over-utilization in health care," CPB Discussion Paper 275, CPB Netherlands Bureau for Economic Policy Analysis.
    9. Ching‐To Albert Ma & Thomas G. Mcguire, 2002. "Network Incentives in Managed Health Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 11(1), pages 1-35, March.
    10. R. Halbersma & M. Mikkers & E. Motchenkova & I. Seinen, 2011. "Market structure and hospital–insurer bargaining in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 589-603, December.
    11. Propper, Carol, 1996. "Market structure and prices: The responses of hospitals in the UK National Health Service to competition," Journal of Public Economics, Elsevier, vol. 61(3), pages 307-335, September.
    12. Annette Tomal, 1998. "The relationship between hospital mortality rates, and hospital, market and patient characteristics," Applied Economics, Taylor & Francis Journals, vol. 30(6), pages 717-725.
    13. David Dranove & William D. White, 1994. "Recent Theory and Evidence on Competition in Hospital Markets," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 169-209, March.
    14. Propper, Carol & Wilson, Deborah & Soderlund, Neil, 1998. "The effects of regulation and competition in the NHS internal market: the case of general practice fundholder prices," Journal of Health Economics, Elsevier, vol. 17(6), pages 645-673, December.
    15. Daniel Kessler & Mark McClellan, 1999. "Designing Hospital Antitrust Policy to Promote Social Welfare," NBER Chapters, in: Frontiers in Health Policy Research, volume 2, pages 53-76, National Bureau of Economic Research, Inc.
    16. David Dranove & William D. White, 1998. "Emerging issues in the antitrust definition of healthcare markets," Health Economics, John Wiley & Sons, Ltd., vol. 7(2), pages 167-170, March.
    17. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1247-1272, July.
    18. Thomas Koch & Shawn W. Ulrick, 2021. "Price Effects Of A Merger: Evidence From A Physicians' Market," Economic Inquiry, Western Economic Association International, vol. 59(2), pages 790-802, April.
    19. Akosa Antwi Yaa & Gaynor Martin S & Vogt William B, 2009. "A Bargain at Twice the Price? California Hospital Prices in the New Millennium," Forum for Health Economics & Policy, De Gruyter, vol. 12(1), pages 1-23, July.
    20. White, William D., 1999. "Physicians and the changing health care marketplace," The Quarterly Review of Economics and Finance, Elsevier, vol. 39(4), pages 439-444.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:envirc:v:16:y:1998:i:4:p:449-462. See general information about how to correct material in RePEc.

    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 CitEc recognized a bibliographic reference but did not link an item in RePEc 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 RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.