Letters The NHS in the simulator

Why expect the rational?

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c294 (Published 19 January 2010) Cite this as: BMJ 2010;340:c294
  1. Peter A West, senior research associate1
  1. 1York Health Economics Consortium, University of York, York
  1. paw11{at}york.ac.uk

    The simulation described in McShane and Smith’s Analysis article sounds like the real commissioning process in the NHS.1 It is not rational because it cannot be. Insufficient data on cost and outcomes for many elements of primary care trust (PCT) commissioning mean that introducing rationality would require immense resources, at the National …

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