The Secretary of State for Health has recently described health care as a form of ‘social investment’ which is ‘of instrumental importance in improving national economic performance’. This concern with economic productivity is shared by decision makers in other countries, where the impact of health care on workplace productivity has been specified as part of the economic analyses to be submitted in support of claims for the public reimbursement of pharmaceuticals.
The UK and Germany are the European leaders in biotechnology. They have many more companies and employees in biotechnology, and much greater sums invested in biotechnology research and development (R&D) than anywhere else in Europe. The two countries’ biotechnology sectors display important differences, however. Also, both remain well behind the US, the global leader in terms of number, size, maturity and profitability of biotechnology companies.
Health systems the world over are striving to manage their available resource to deliver the best value for the public’s health. For most nations, the general medical practitioner (GP) is the keystone of their organizational approach to achieving the best mix of quality, public and individual satisfaction, and cost. England’s latest reforms point towards a national health system that employs GPs – individually and in groups – as the micromanagers of resource and of care.
Most countries regulate manufacturer prices for pharmaceuticals, either directly (France, Italy) or indirectly through controls on reimbursement (Germany, Japan) or profits (the UK). It is widely believed that drug prices are lower in countries with strict price regulation than in countries with less restrictive regulation (the UK) or no regulation (the US). For example, the BEUC (1989b) concluded that prices in the UK and the US were, respectively, 20 and 54 percent above the EEC average, whereas those in France and Italy were, respectively, 30 and 28 percent below the EEC average.
This paper examines general issues in the use of benchmarking as a measure of comparative performance, reviews the application of benchmarking in the public and private sectors, and then examines the application of benchmarking in the UK National Health Service (NHS). A key issue of concern is whether there should be a link between benchmarks and explicit financial rewards, and the implications for the form of the benchmark if such links are made.
Writing on the future of Primary Care Groups/Trusts, and of Labour’s health service reforms in general, invites subsequent ridicule by those blessed with the clarity of vision hindsight provides. The fact is that only the brave or foolish posit with any certainty how these latest changes to the UK National Health Service (NHS) will unfold. Nevertheless, this paper paints some scenarios, and at the end attempts to predict the future of the reforms.
Health and economic development is positively linked. External investments are needed to break the vicious cycle of poor health and poverty plaguing less developed countries (LDCs).
Measured in disability adjusted life years (DALYs), the disease burden suffered per person in LDCs is twice that of people in established market economies (EMEs). The two regions also have distinct disease patterns with almost 40 percent of LDCs’ healthy years lost to communicable, maternal, and prenatal diseases as opposed to only 8 percent in EMEs.
Most health care systems are characterised by both purchasers (insurers, health authorities), who buy health care for a particular population, and providers (hospitals, primary care physicians), who supply health care services. In circumstances where the purchasers or providers bear any of the financial risk associated with covering a population, incentives to prefer to ‘risk select’ are present; i.e. purchasers will prefer to provide cover for people who are likely to require relatively little health care.