Paid for by the NHS, treated privately
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3109 (Published 10 June 2015) Cite this as: BMJ 2015;350:h3109- John Appleby, chief economist, King’s Fund, London, UK
- j.appleby{at}kingsfund.org.uk
Central to the 1990 reforms of the NHS was the idea that by separating purchasers of care from providers, with the purchasers holding the money (but no services) and the providers services (but no money), the transactions that would need to take place would drive up quality and efficiency.1 Health authorities would be active purchasers of care on behalf of their resident populations. And in this “internal market” there would be freedom to shop around for the best deals from any organisation willing to supply, whether state owned or independent sector.
There have been several reboots of the original idea since then. Internal market 2.0 from the 2002 Labour administration emphasised patient choice and encouraged more private …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £173 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£38 / $45 / €42 (excludes VAT)
You can download a PDF version for your personal record.