: Are you still going to send it Lark??
: I hope you will it would be really useful.If it's not to late that is. Here's a brief run down. I've got my dissertation to do so times short.
Our story begins in the US, the fact that the providers of insurance, the source of finace for operations and meidical care, where seperate from the providers of care, the hospitals, was proving highly problematic. Hospitals had no incentive toward efficiency, in care provision and resource allocation, and a definite tendency toward over provision and unecessary care because the costs wherent their concern.
So the idea came about that the purchaser and provider of welfare should be fused into one unit, now people would buy insurance from the private hospitals and the hospitals would then have an incentive towards cost cutting an and a disincentive towards overprovision.
This hasent been the dream it should have been in the US because rather than doctors and hospitals being enlightened entreprenours and inventing sources of insurance, insurance salesmen invented sources of health care. That sounds complicated but basically doctors didnt want to become finacers/accountants and as a result could just seek employment from them. Now super insurance corps control the access to employment and doctors do not have the freedom to determine what treatment they view as the best if they wish to keep their jobs and they must consider their boss's line or prespective.
Anyway back to the UK, the thatcher government thought that the problem with the NHS in Britain reflected that in the US the balance of purchaser/insurance provider and health care was wrong. So they split the NHS into trusts who would vie for attention and funding from the government and be granted the funding on the basis that they are populaar and they must be efficient etc. to be popular. The thatcherite reform also introduced GP fundholders whereby GP's with sufficiently large customers/patient basis would be given funds to work with autonomiously.
The problems have been that any gains made in efficiency through competition have been reinvested not in Health care and new technology but in management and bureaucratic costs, GP fundholders and trusts are not popular because they provide good services but because they are demographically well located EG in a central town, new old communities etc., GP fundholders arent as autonomous as was suggested and arent allowed to spend as the like incase they increase costs.
The Thatcherite reforms where driven by a need to cut costs to allow for politically expedient tax cuts and have resulted in increases not decreases in costs because they where implemented in a hurried and ideological rather than gradual and logical fashion. Blairs administration is trying to work out a means of preserving the system while abolishing a lot of the management positions that have created such costs etc. the split without competition, co-operativeism rather than capitalism, I'm cynical about any kind of success and I think a reversion to the Beveridge plan style of NHS would be progressive and once there problems like increased expectations, the development of costly and specific types of care like viagra or cancer operations could be dealt with through decentralisation of planning and increases in taxation.
None.
