Self-governing Hospitals in a Public Funded Health Care System: NHS trusts in Britain and independent hospitals in Canada

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Abstract
The British National Health Service, in common with many other European countries, is undergoing a period of radical reform. One of the most important and fundamental changes introduced is the right for hospitals and other provider units to apply for self-governing (autonomous) status. Self-governing hospitals are a new phenomenon in Britain and there is little understanding or evidence of how the policy change will impact on health services delivery. This paper explores the likely development in Britain of the self-governing hospital from the perspective of the hospital in the Canadian Health System. Canada has a comprehensive, government funded and regulated system of health care, free at the point of delivery and available to all citizens. Its hospitals operate as autonomous institutions within the overall structure. The paper considers the issue of self governance from four perspectives: management; finance; service provision; and accountability. The paper concludes that autonomously managed hospitals are compatible with a public funded health care system.

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