It may seem odd that someone from the most overpriced, wasteful and inequitable health care system in the industrialised world should pen a report on how to make the UK National Health Service (NHS) more cost-effective. Yet from the very deregulated nature of US markets have emerged useful lessons, as the leading buyers (that's American for 'commissioners') face up to all the ways that they did not save money during the 1980s when they thought they had. My aim is to employ familiarity with both systems in order to extract 'adaptable policy lessons' that could be used in the UK.
Caught between rising expenditure, suspected room for improved efficiency and dwindling availability of public funds, Germany's health care system is now in the forefront of public debate. In 1989 and 1993, two major legislative attempts to reform the German health sector brought home the futility of seeking to solve its problems unless the underlying structures are first reshaped. Even with the most recent health care reform, passed in July 1997, the basic characteristics of the German health care system remain largely unchanged.
This paper examines the potential for managed care techniques to develop in the UK National Health Service. It begins with a review of managed care approaches but no attempt is made here to review the wealth of material on managed care in the USA. The reasons for attempting tighter management of care and the main tools used are examined. Existing elements of the managed care approach in the NHS are then examined and the need and scope for further use of managed care tools in the NHS are explored. Finally, the potential contribution of the private sector to care management is discussed.
The 1989-1991 Conservative reforms of the National Health Service (NHS) introduced fundamental changes in the organisation of health care in the UK. At the same time they emphasised for the first time in the context of the NHS the potential benefits to patients and taxpayers of competition between care providers.
I am greatly flattered to be invited to deliver the 1998 annual lecture of the Office of Health Economics, partly on account of my distinguished predecessors, but also because this invitation provides an opportunity for a more explicitly historical perspective than is usual on these occasions. This year of the fiftieth anniversary of the National Health Service(NHS) is an especially appropriate opportunity for such an exercise.
If a dart were thrown at a map of the world and one identified the national capital nearest the dart, the following would be a safe prediction: somewhere in that capital a task force is busily at work on yet another a blueprint for health-care reform. The prediction is safe because, at any time, in any nation, there is widespread malaise over that nation's health system. Furthermore, the alleged shortcomings of the current system are everywhere the same.
Faced with the growing pressures on health care budgets, policy makers around the world have turned to different forms of direct charging for health services. However, because it is rare to find a health system where the user is faced with the full cost of the service, these charges are often referred to as cost sharing. That is, the cost of the service is shared between the user and some third party payer, typically a sickness fund, insurance company or government agency.
Increases in expenditure on medicines, above the level of increases in health care expenditure generally, are a feature of all Western health systems, including the UK's. This paper examines the causes of these increases in the UK. It reports on a study carried out by the Office of Health Economics, with technical assistance from the Department of Health, under the auspices of the Industry Strategy Group, a forum for joint discussion of matters of strategic interest to the pharmaceutical industry and the Government.
Much has been written over the last 40 years bemoaning the state of NHS waiting lists. Contributions to this literature have come from diverse fields; from epidemiologists, surgeons, statisticians, operations researchers, managers and social scientists (Pope, 1990) (Mullen, 1993), (Yates, 1987).
Getting value for money from the use of pharmaceuticals is crucial for the NHS. This publication explores the role for guidelines in generating good quality value for money information examining the experience of Australia, Canada and the UK – the first three health care systems to introduce national guidelines for economic assessments.