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The English National Health Service: 1979-2005


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  • Adam Oliver

    (LSE Health and Social Care, London School of Economics, London, UK)

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    This article aims to assess the development of the English National Health Service (NHS) over the period 1979-2005, against the original, and often repeated, core objectives of the system: that it be universal in offering coverage to all members of the population in times of health care need; that it be comprehensive in its provision of health care services; and that it be (largely) free at the point of use. Comprehensiveness is open to interpretation, and may depend upon the wealth of the nation. Universality and (largely) free care at the point of use, which lend themselves to the principle of equal access for equal need, are more concrete, and it is not difficult to ascertain if they have been substantially and|or systematically violated. The article details briefly the developments in resource allocation, provider payment mechanisms, incentives and accountability, and notes that much of the emphasis on health sector change since the mid 1980s has been placed upon improving supply side efficiency and reducing waiting lists|times. Improving NHS efficiency, and indeed related aspirations associated with choice and health outcomes, can be perceived as 'secondary' objectives, in that they should not serve to undermine the core objectives of the system, assuming that the security offered by having an accessible, universal health care system is considered worthy of protection. The overall conclusion is that the NHS has performed quite well against its core objectives to date, although it is possible that the current preoccupation with choice and health outcomes will lead us down a different policy path in the future. Copyright © 2005 John Wiley & Sons, Ltd.

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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 14 (2005)
    Issue (Month): S1 ()
    Pages: S75-S99

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    Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s75-s99

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    1. Matsaganis, Manos & Glennerster, Howard, 1994. "The threat of 'cream skimming' in the post-reform NHS," Journal of Health Economics, Elsevier, Elsevier, vol. 13(1), pages 31-60, March.
    2. Wailoo, Allan & Anand, Paul, 2005. "The nature of procedural preferences for health-care rationing decisions," Social Science & Medicine, Elsevier, Elsevier, vol. 60(2), pages 223-236, January.
    3. Andrew Street & Sawsan AbdulHussain, 2004. "Would Roman Soldiers Fight for the Financial Flows Regime? The Re-issue of Diocletian's Edict in the English NHS," Public Money & Management, Chartered Institute of Public Finance and Accountancy, Chartered Institute of Public Finance and Accountancy, vol. 24(5), pages 301-308, October.
    4. Peter C. Smith & Nigel Rice & Roy Carr-Hill, 2001. "Capitation funding in the public sector," Journal of the Royal Statistical Society Series A, Royal Statistical Society, Royal Statistical Society, vol. 164(2), pages 217-257.
    5. Eddy van Doorslaer & Xander Koolman, 2004. "Explaining the differences in income-related health inequalities across European countries," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 13(7), pages 609-628.
    6. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income-related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 13(7), pages 629-647.
    7. repec:rus:hseeco:124076 is not listed on IDEAS
    8. Amartya Sen, 2002. "Why health equity?," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 11(8), pages 659-666.
    9. Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, Elsevier, vol. 11(3), pages 279-296, October.
    10. Diane Dawson & Rowena Jacobs & Steve Martin & Peter Smith, 2004. "Is Patient Choice an Effective Mechanism to Reduce Waiting Times?," Applied Health Economics and Health Policy, Springer Healthcare | Adis, Springer Healthcare | Adis, vol. 3(4), pages 195-203.
    11. Karen Bloor & Alan Maynard & Andrew Street, 1999. "The cornerstone of Labour's 'New NHS': reforming primary care," Working Papers, Centre for Health Economics, University of York 168chedp, Centre for Health Economics, University of York.
    12. Goddard, Maria & Smith, Peter, 2001. "Equity of access to health care services: : Theory and evidence from the UK," Social Science & Medicine, Elsevier, Elsevier, vol. 53(9), pages 1149-1162, November.
    13. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, Elsevier, vol. 19(5), pages 553-583, September.
    14. Peter C. Smith, 2003. "Formula Funding of Public Services: An Economic Analysis," Oxford Review of Economic Policy, Oxford University Press, Oxford University Press, vol. 19(2), pages 301-322, Summer.
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    Cited by:
    1. Toth, Federico, 2010. "Healthcare policies over the last 20 years: Reforms and counter-reforms," Health Policy, Elsevier, Elsevier, vol. 95(1), pages 82-89, April.
    2. Joanne Castonguay & Claude Montmarquette & Claude Castonguay & Iain Scott, 2007. "Analyse comparative sur le financement de la santé," CIRANO Project Reports, CIRANO 2007rp-04, CIRANO.
    3. Gugushvili, Alexi, 2007. "The advantages and disadvantages of needs-based resource allocation in integrated health systems and market systems of health care provider reimbursement," MPRA Paper 3354, University Library of Munich, Germany.


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