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.
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.
This Conference on Genomics, Healthcare and Public Policy, organised by the Office of Health Economics in collaboration with the School of Public Policy, University College London, and Pharmaceutical Partners for Better Healthcare, examined the status and likely consequences of healthcare applications of genetics. Advances in genetics will open up opportunities for universities and industry, they will induce changes in the practice of medicine, and lead to alterations in the structure and organization of health services in many countries.
International and UK experience illustrates the difficulty of involving the publica in health caare priority setting in ways that enable politicians, managers and doctors to incorporate public preferences into practical decision making.
Many techniques for measuring public preferences fail to incorporate key concepts:
opportunity cost. What are people prepared to give up or have less of, in order to have more of something else? The public have to be asked to make trade-offs;
• The integration of health care is the defining theme of policy developments in the UK, US and New Zealand. The common element between the three countries has been the development of multipractice and multi-professional groups in primary care settings.
• International learning has become commonplace and has accelerated the introduction of innovations in the UK.
There is widespread criticism of organisational costs in the NHS. 'Reduce bureaucracy, release funds for patient care' has become a popular slogan. This so-called 'bureaucracy' may, however, be essential to delivering health care. The complexity of modern health care means that some organisational costs have to be incurred if the right health care is to go to the right people at the right time.