Competition, cooperation, or control? Tales from the British National Health Service

The British National Health Service (NHS) recently underwent a massive social experiment, inspired in large part by the ideas of U.S. experts. This involved the creation of an internal or quasi-market, separating purchaser from provider and encouraging competition among providers. After reviewing th...

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Bibliographic Details
Published in:Health Affairs 1999-05, Vol.18 (3), p.27-39
Main Author: Le Grand, J
Format: Article
Language:English
Subjects:
Budgets
Bureaucracy
Central government
Community health care
Competition
Cooperation
Cooperative Behavior
Economic Competition
Economics
Efficiency
Experiments
Experts
Financing, Government
Health
Health care
Health care policy
Health Care Reform
Health maintenance organizations
Health Policy
Health services
HMOs
Hospitals
Humans
Markets
National health insurance
Nonprofit hospitals
Performance management
Politics
Primary care
Prime ministers
Privatization
Public health
Reforms
Retention
Social policy
Social research
State Medicine - economics
State Medicine - organization & administration
Studies
United Kingdom
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Summary:The British National Health Service (NHS) recently underwent a massive social experiment, inspired in large part by the ideas of U.S. experts. This involved the creation of an internal or quasi-market, separating purchaser from provider and encouraging competition among providers. After reviewing the evidence concerning the impact of this experiment, I conclude that the impact in fact was minimal, partly because of the retention of central government control and partly because the experiment was based on an inadequate understanding of professional and managerial motivations. The paper draws out general lessons of the experiment for other market-oriented health care systems and examines whether the lessons are reflected in the new batch of NHS reforms initiated by the recently elected Labour Government.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.18.3.27