Few countries are immune to the international health care 'virus' of reform, with many countries regularly re-cycling changes that shift costs and benefits in ways that are arbitrary, inefficient and offer short term political palliation. Much of this activity has little evidence base and reveals lack of clarity in defining public policy goals, establishing trade-offs and aligning incentive structures with these objectives. Well established failures in health care delivery systems such as variations in medical practice and continuing absence of systematic outcome measurement, have persisted for decades as nations grapple inefficiently with recurring problems of expenditure inflation and waiting times. The lack of emphasis on evidence to inform the efficient management of chronic disease and the reduction of health inequalities is a product of perverse incentives and managerial inertia that maintains the incomes of powerful interest groups.

Europe↗

PubMed2005

The contestable nature of health policy analysis.

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Europe↗

PubMed2005

Competition in health care: what does it mean for nurse managers?

The English Government has launched a series of radical market-orientated reforms whose goal is to get the National Health Service to 'act smarter' by undermining with public-private competition the monopoly power of providers, in particular 'inflexible' National Health Service hospitals and medical practitioners. The failure of nurses and managers to remedy well established problems in the delivery of health care, for instance variations in medical practice, medical errors and the continued absence of measures of patient outcome or clinical success, together with slow changes in waiting time performance, has persuaded Mr Blair to use the market to induce more rapid change. Whether this unevaluated and radical social experiment will succeed is impossible to forecast precisely. However, it will oblige nurse managers to have increased recourse to the evidence base and the need to translate such material in improved practice. It will also oblige them to be able to access and use in their day-to-day management improved administrative data about practice activity and patient outcomes.

Economic Competition↗

PubMed2005