Disputes in the NHS Internal Market: Regulation and Relationships

1996 ◽  
Vol 2 (3) ◽  
pp. 215-227 ◽  
Author(s):  
J.V. McHale ◽  
D. Hughes ◽  
L. Griffiths
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Dispute Resolution ◽  
Empirical Research ◽  
National Health ◽  
Community Care ◽  
Internal Market ◽  
Market Regulation ◽  
Direct Management

An important element in the NHS internal market, introduced by the national health Service and Community Care Act 1990, was the “NHS” contract — an agreement between purchasers and providers who were within the NHS but who were not in a direct management relationship to each other. The framers of the legislation intended that such contracts should be excluded from judicial enforcement and instead be subject to a special statutory dispute resolution procedure. This paper examines those factors which have impacted upon the resolution of NHS contractual disputes in practice drawing upon empirical research undertaken as part of an ERSC funded study.

Psychiatric Out-Patients in Plymouth—An Area Service Analysed

1965 ◽  
Vol 111 (470) ◽  
pp. 10-17 ◽  
Author(s):  
Neil Kessel ◽  
Christine Hassall ◽  
Robert Blair ◽  
John M. Gilroy ◽  
Francis Pilkington ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Mental Hospital ◽  
Psychiatric Care ◽  
Community Care ◽  
Psychiatric Patients ◽  
Patient Department

Out-patient services in Britain for psychiatric patients have expanded enormously under the National Health Service. Well over half a million patients are seen at clinics annually. Concomitant with this increase the out-patient department has changed in function. No longer is it principally concerned with providing follow up and support for discharged mental hospital in-patients; instead, because of the greatly increased demand for psychiatric care for less severe disorders and under the influence of the movement for community care it now should play a part not at all subservient to the in-patient department. The clinic, properly run, should be an arena of treatment in its own right.

Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?

2010 ◽  
Vol 5 (3) ◽  
pp. 343-363 ◽  
Author(s):  
Gwyn Bevan ◽  
Wynand P. M. M. van de Ven
Keyword(s):  
National Health Service ◽  
Health Service ◽  
The Netherlands ◽  
National Health ◽  
Thought Experiment ◽  
Internal Market ◽  
Patient Choice ◽  
Market Model ◽  
English National Health ◽  
English National Health Service

AbstractIn the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.

Competition in the Mixed Economy of Care

1996 ◽  
Vol 25 (2) ◽  
pp. 201-221 ◽  
Author(s):  
Julien Forder ◽  
Martin Knapp ◽  
Gerald Wistow
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Social Welfare ◽  
National Health ◽  
Market Failure ◽  
Social Care ◽  
Community Care ◽  
Economic Framework ◽  
Social Welfare Services ◽  
Basic Understanding

ABSTRACTThe 1990 National Health Service and Community Care Act introduced sweeping changes to health and social welfare services. The reforms to community care were dominated by the introduction of markets for social care. We argue that the new markets cannot be guaranteed to deliver the range of services required to meet community care objectives. When they began to assume their new responsibilities, few key purchasers had a basic understanding of the functioning and imperfections of markets. Consequently, they were poorly equipped to anticipate or ameliorate the sources of market failure that we identify. Like any other relatively ill-informed purchaser, local authorities risk being unable to buy what they want on behalf of their residents and at an appropriate volume, cost and quality. We discuss where and how market imperfections are likely to occur. In this context, we offer an economic framework to help in the shaping and managing of social care markets.

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