Biomedical subjects
Publications and source records attributed to H Glennerster.
An analysis of English trusts' annual reports found that more than half include waiting list information. A quarter were very basic and left out any information on activity and/or governance. Trusts are increasingly likely to include information on the quality of services.
OBJECTIVES: The aims of this paper are threefold: first to review briefly the theoretical literature on competition and its predicted effects on health care quality; secondly to describe the attempts to introduce competition into the UK National Health Service (NHS); and third to review the outcomes of this experiment and ask how far the research findings are consistent with the next phase of reform that the new Labour Government proposed in late 1997. DATA SOURCES: A search was conducted using electronic data bases Unicorn, Medline and Health Planning and official monitoring statistics within the NHS. All references relating to district-based purchasing, general practitioner (GP) fundholding in its various forms and GP commissioning were reviewed. STUDY SELECTION: Preference was given to prospective before and after studies with and without control groups, retrospective studies with and without controls, and case studies which were reinforced by similar supporting case studies. RESULTS OF DATA SYNTHESIS: The evidence suggests that there was little overall change for good or bad as a result of the reforms. The changes that did occur had an impact on speed of treatment, patient convenience and choice, but medical quality was largely unaffected. These benefits were reaped, in particular, by the more competitive agents - the family doctors or GPs. CONCLUSION: Although not dramatic in outcome, these changes were significant because speed and convenience were the main deficiencies of the NHS in the eyes of UK consumers.
The new Labour government in the United Kingdom is proposing to adapt the reforms begun by the last Thatcher government. In particular, it is proposing to abolish the most controversial element--general practitioner (GP) fundholding. It is looking for alternatives. The study reported here followed and evaluated several such schemes. While fundholders use their purchasing power directly to force change by threatening "exit" to another provider, other GPs have evolved ways of influencing decisions--enhancing their "voice." The authors develop a theory to predict the conditions favoring the relative success of exit and voice strategies in health purchasing, and describe alternative GP-based purchasing schemes and the reasons they evolved in six sample districts. In four of these districts and eight practices in each, fundholding and non-fundholding GPs were then asked to describe their intentions and the outcomes of the purchasing process in which they had participated. Four specialties were taken as examples. The authors compare the relative success of fundholders and non-fundholders in achieving their objectives.
The general practice fundholding scheme was introduced four years ago. So far its impact has not been formally evaluated nationally, but review of published research shows some trends. Fundholding has curbed prescribing costs and given general practitioners greater power to lever improvements in hospital services--for example, reducing waiting times for hospital treatment--but fundholding practices may have received more money than non-fundholding practices. The impact of fundholding on transactions costs, equity, and quality of care (particularly for patients of non-fundholding general practitioners) is unknown. Research into costly reforms such as fundholding needs to be coordinated.
In the late 1980s, governments in many western economies began to introduce competition between public agencies providing health, education, and other forms of social welfare. Government became a contracting agency separating funding from provision. The United Kingdom went farthest in legislation passed between 1988 and 1990. The authors review some possible explanations for this fundamental change. The article draws on public choice theory and broader political science approaches and reviews the evidence on the impact of the changes. The gains from these changes may be small, and the result may be only the build up of pressure for more spending in the longer term.
The allocation of budgets to general practitioners to enable them to purchase selected hospital services has been one of the most imaginative elements of the recent National Health Service reforms in Britain. However, reliance on 'historic costs budgeting' has weakened the efficiency incentives of fund-holding, while perpetuating the large variations in resource use endemic in general practice. On the other hand, policy changes aimed to introduce elements of capitation funding, although welcome, raise the spectre of 'cream skimming'. The paper explores the potential for protection against 'cream skimming' offered by incorporating chronic health factors into the formula.
England and Sweden have two of the most advanced systems of universal access to health care in the world. Both have begun major reforms based on similar principles. Universal access and finance from taxation are retained, but a measure of competition between providers of health care is introduced. The reforms therefore show a movement toward the kind of approach advocated by some in the United States. This article traces the origins and early results of the two countries' reform efforts.
In April 1991 the UK embarked on the most radical reforms of its health care system in 50 years. Unusually it employed two quite distinct models of quasi market reform. One made District Health Authorities the purchasers of hospital and community health services. The other gave family doctors the money to buy these services on behalf of their patients. This latter model was the most radical part of the NHS reforms. This paper reports on a project that has monitored the family doctor fundholding scheme in detail.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.