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.
The objective of this report is to provide an assessment of the reform process of the health care sector in the Countries of Central and Eastern Europe (CCEE). It shall assess the overall direction of the reforms and focus in particular on health financing and pharmaceutical policy making as two important elements of structural reform. The first part of this report provides a brief overview of the state of health of CCEE populations and the process of health care reform. The second part of the report discusses health financing and pharmaceutical policy reform.
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.
In April 1991, a radical programme of public health care reform was introduced by the Conservative Government. The avowed intention of the programme was to improve the overall quality of health care whilst simultaneously moderating the growth in costs. Within the general reform package, prescribing in general practice was a particular focus of attention.
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).
In this OHE lecture Professor Sackett sets out a compelling case for evidence-based medicine to be at the core of a comprehensive, tax-funded NHS that enjoys the confidence of the whole population. He also sets out his personal view as to how the conflict between a doctor's responsibilities to each individual patient and to society can be minimised and managed, but not eliminated.