Why Britain Is Reorganizing Its National Health Service—Yet Again

Open Access
Publisher Website
Google Scholar
Abstract
PROLOGUE: As even casual observers know, in spite of America's tradition of robust capitalism, there is a long-standing debate in this country over the merits of economic competition. This debate often reaches a fevered pitch when it comes to health care markets, where it is not unusual to find even staunch capitalists arguing in favor of a conspicuous regulatory presence against those who claim that health care is just another consumer good. Participants in this debate might do well to look to Britain, where the National Health Service's experiment with “internal markets” was recently scuttled by Labour-led reforms. At first glance this might seem a victory for opponents of competition in health care markets. However, as revealed in this paper by Rudolf Klein, a closer examination of these reforms and the trends surrounding them reveals a complicated picture that is more likely to reignite debates over fundamental issues than it is to settle old scores. A former journalist, Klein is a longtime student of British health policy who made the switch to academe in 1978, when he became professor of social policy at the University of Bath (now professor emeritus). Since 1996 he also has been a visiting professor at the London School of Economics. Over the years Klein's work has appeared regularly in numerous policy journals, both here and abroad, and in a collection titled Only Dissect: Rudolf Klein on Politics and Society (Blackwell, 1996). In addition, he has published several books, among them The New Politics of the National Health Service (Longman, 1995). The Labour government's 1997 plans for Britain's National Health Service (NHS) have been presented as a reaction to the reforms introduced by its Conservative predecessor in 1991. But to a large extent they build on the Conservative legacy. The centerpiece of the Labour reform—managed care organizations based on groups of primary care physicians—is based on the Conservative experiment with general practitioner fund holding. Welcomed when published, Labour's plans may arouse opposition in implementation, for they imply greater central control and threaten medical autonomy. If the political costs are to be contained, Labour may have to choose between increasing spending on the NHS or making concessions to the medical profession—and quite possibly have to do both.