Should the NHS follow the American way?

doi:10.1136/bmj.331.7528.1328

BMJ 2005;331:1328-1330 (3 December), doi:10.1136/bmj.331.7528.1328

Education and debate

The NHS revolution: health care in the market place

Should the NHS follow the American way?

Cam Donaldson, Health Foundation chair in health economics¹, Danny Ruta, senior lecturer in epidemiology and public health¹

¹ School of Population and Health Sciences, University of Newcastle, Newcastle upon Tyne NE2 4AA

Correspondence to: C Donaldson cam.donaldson@ncl.ac.uk

Managed care and patient choice have many good points, but theNHS needs to adapt US methods if it is to be efficient, free,and fair

The first 150 words of the full text of this article appear below.

Introduction

The UK government seems to draw much of its inspiration forhealth policy from the United States. Hence the recent loveaffair with Kaiser Permanente's care pathways and the recentaffirmation of the belief that choice and payment by resultswill move England towards a patient led NHS.¹ Using evidencefrom the US and Canada, we question this source of inspiration,raise the possibility that the current policy trajectory willlead to greater private financing of health care, and outlinewhy the United Kingdom should be wary of this. We then suggesta solution to financing that retains some aspects of managedcare and current policy but rejects others. Our solution recognisesthe cash limits of the NHS and its twin goals of equity andefficiency.

Did managed care work in the US?

It is easy to interpret managed care in the US as having ledto greater efficiency in terms of outcomes and cost.² However,managed . . . [Full text of this article]

From patient led NHS to user charges

Is there an alternative?

Conclusion

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Rapid Responses:

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