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?

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

Managed care and patient choice have many good points, but the NHS 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 for health policy from the United States. Hence the recent love affair with Kaiser Permanente's care pathways and the recent affirmation of the belief that choice and payment by results will move England towards a patient led NHS.¹ Using evidence from the US and Canada, we question this source of inspiration, raise the possibility that the current policy trajectory will lead to greater private financing of health care, and outline why the United Kingdom should be wary of this. We then suggest a solution to financing that retains some aspects of managed care and current policy but rejects others. Our solution recognises the cash limits of the NHS and its twin goals of equity and efficiency.

Did managed care work in the US?

It is easy to interpret managed care in the US as having led to 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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efficient

benjamin dean
bmj.com, 6 Dec 2005 [Full text]

should the NHS go the American Way

Arif S Syed
bmj.com, 8 Dec 2005 [Full text]

Let me opt out of NHS

Ramakant Sharma
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Re: efficient

Andrew Montgomery
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Re: Let me opt out of NHS

L S Lewis
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good point

ben dean
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