Introducing a market to the United Kingdom's National Health Service

Article Abstract:

The success of organizational reforms of the United Kingdom's National Health Service (NHS) is difficult to determine. In 1991, the NHS was restructured in order to encourage competition, which, it was hoped, would contain costs and allocate resources more equitably. Hospitals became publically owned, self-governing trusts. They were to generate income through contracts with health care purchasers. Large general practices were also permitted to become fundholders. It was hoped that competition and more localized decision making would reduce costs and make care more responsive to community need. However, a simultaneous increase in funding makes it difficult to judge the effectiveness of reforms. Evaluation has been lacking, and where it has been done, it has found little improvement. As examples, wait times for nonemergency care have not been reduced, spending on drugs has not consistently been reduced, underuse of some technologies and overuse of other procedures has been found, and some regulations have been counterproductive.

Management, United Kingdom. National Health Service

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The states and health care reform

Article Abstract:

Universal health care was first proposed by Harry Truman in 1945, but subsequent administrations and Congresses have failed to legislate health care reform. Consequently, several states have enacted their own plans. The most successful plan is Hawaii's, which has been in place since 1974. Hawaii's experience has shown that employer-mandated health insurance does work. Hawaii has only a few third-party payers, which has helped keep costs down. Every Hawaiian resident has access to good primary care, and the state is considering legislation that would make primary care physicians the gatekeepers who would refer patients to specialists. A study at the University of Hawaii found that a four percent surcharge on insurance premiums would pay for health care for all those who are not covered. This is half what some states are now paying for uncompensated care. Health care reform would not have to be funded by increased taxes. The federal government needs to get involved in national health care reform.

Editorial, Planning, Social policy, Health care reform, Hawaii, State government

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