Markets in health care: taking a tiger by the tail?

Abstract

AS THE UNITED KINGDOM National Health Service (NHS) moves towards structural reorganisation once again, both ?contestability? and ?choice? reflect the underlying theme of the current reforms: that is, an open market in health care. This paper describes how this reform has come into being and the implications for the UK, but also for the wider developed world. The NHS was established on the wave of altruistic community spirit that followed the end of the Second World War, when the new Labour government introduced publicly funded education and social care as well as health services. In what may be characterised as a ?socialist? model of care, individual needs were often subsumed into the needs of society at large, and egalitarianism and perceived fairness trumped any sense of consumerism. Paternalistic professionals ?knew best?, and grateful patients joined the queues that ensured that there was a steady ?header tank? of users to keep expensive hospitals running at a set capacity, and hence a set efficiency. The NHS was perceived as the envy of the world because it seemed to manage to squeeze a quart of activity out of every meagre pint of funding. Moreover, in this model of planned health care (a local hospital in every district, and general practitioners distributed to ensure a fair population coverage), public services were funded through general taxation and were all delivered by public organisations employing public servants, working alongside each other for the common good.