Maynard Matters: A New Publication Covering Alan Maynard’s Contribution to Global Health Economics

Maynard Matters is a new publication edited by Richard Cookson, Maria Goddard and Trevor Sheldon, published by University of York, Centre for Health Economics (CHE).

This new publication combines new pieces by leading health economists with extracts from Alan Maynard’s work on efficiency and equity, quality and outcomes, health care financing, markets and competition, workforce, primary care budget holding, pharmaceutical purchasing, and alcohol & drug abuse.

Contributors include OHE’s Research Director Professor Nancy Devlin, OHE Research and Policy Committee member Tony Culyer and past OHE Annual Lecturer Bob Evans. The publication covers Alan’s contribution to global Health Economics, his thinking about the UK NHS, and his role as a the Founding Director of CHE, as the Founding Editor of the journal Health Economics and as Chair of York Hospital NHS Foundation Trust.

One of the papers from Alan in the book, “Performance incentives in general practice”, is his call for GP budget holding at an OHE meeting held in 1985. This paper is part of Health, Education and General Practice (1985), which is available on the OHE website.

In this paper he argues for clearer specification of the basic care package, better information for patients, greater experimentation using pilots of different approaches to running and incentivising GP practices, changes in the doctors contracts, the requirement for all drugs and practices to have proven worth and value for money before being introduced, and community pharmacy to improve GP prescribing as well as for GP fundholding. Each of these ideas has led to a policy implementation, many of which were subsequently shown by researchers to generate benefits.

Alan’s robust approach to using economic thinking to recommend policy to deliver the collective funding of cost-effective health care was also present in his 20th OHE Annual Lecture, which he gave in 2013, five months after release of the Francis Report. This detailed report made 290 recommendations for more regulation. "Sadly", Maynard notes, "[Francis’s] proposals were not evidenced, not prioritised and not costed".

UK responses to perceived problems in health care quality, he notes, have produced continuous structural “re-disorganisation” over the past 40 years. These rarely have been evidence based; the disruptions created often were more profound than any improvement.

The alternative to "more regulation (as advocated by lawyers and public inquiries) is better regulation", according to Alan Maynard. Better regulation, in turn, is based on evidence and economic analysis. Outcomes measurement is at the core of the economic approach to reforming health care. Understanding outcomes, in turn, allows the adoption of effective incentives for change, both financial and non-financial.

Maynard Matters is available for free download as a pdf and as an e-reader here.

A separate CHE web page is also dedicated to stories and messages from friends, colleagues and students.

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