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The English National Health Service: 1979‐2005

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  • Adam Oliver

Abstract

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.

Suggested Citation

  • Adam Oliver, 2005. "The English National Health Service: 1979‐2005," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 75-99, September.
    • Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s75-s99
    DOI: 10.1002/hec.1029
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    Cited by:

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    3. Gorgemans, Sophie & Urbina-Pérez, Olga, 2022. "New legal forms in health services: Evaluation of a Spanish public policy," Health Policy, Elsevier, vol. 126(8), pages 802-807.
    4. Run Liang & Hao Wang, 2017. "Health insurance, market power, and social welfare," International Journal of Economic Theory, The International Society for Economic Theory, vol. 13(4), pages 427-442, December.
    5. Joanne Castonguay & Claude Montmarquette & Claude Castonguay & Iain Scott, 2007. "Analyse comparative sur le financement de la santé," CIRANO Project Reports 2007rp-04, CIRANO.
    6. 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.
    7. Shimaa Elkomy & Graham Cookson, 2020. "Performance Management Strategy: Waiting Time in the English National Health Services," Public Organization Review, Springer, vol. 20(1), pages 95-112, March.
    8. Aarden, Erik & Van Hoyweghen, Ine & Horstman, Klasien, 2011. "Constructing access in predictive medicine. Comparing classification for hereditary breast cancer risks in England, Germany and the Netherlands," Social Science & Medicine, Elsevier, vol. 72(4), pages 553-559, February.
    9. Garcia-Prado, Ariadna & Gonzalez, Paula, 2007. "Policy and regulatory responses to dual practice in the health sector," Health Policy, Elsevier, vol. 84(2-3), pages 142-152, December.
    10. Nikolova, Silviya & Sinko, Arthur & Sutton, Matt, 2015. "Do maximum waiting times guarantees change clinical priorities for elective treatment? Evidence from Scotland," Journal of Health Economics, Elsevier, vol. 41(C), pages 72-88.
    11. Petrakaki, Dimitra & Klecun, Ela & Cornford, Tony, 2016. "Changes in healthcare professional work afforded by technology: the introduction of a national electronic patient record in an English hospital," LSE Research Online Documents on Economics 59475, London School of Economics and Political Science, LSE Library.

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