Effective Commissioning: Lessons from Purchasing in American Managed CareBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7159.689a (Published 05 September 1998) Cite this as: BMJ 1998;317:689
- Jennifer Dixon, fellow in policy analysis
- King's Fund, London
Donald W Light
Office of Health Economics, £7.50, pp 90
ISBN 1 899040 552
In some ways the NHS has changed enormously since 1991. Purchasers were put in the driving seat, needs were assessed, explicit priorities were drawn up, shifts in investment were made, and fundholders wrought changes in areas that had irked them for years. But in other ways, surprisingly little was achieved considering the changes in funding and organisation that went into making the split work.
Why? The instrument of change was purchasing, and this dog not only failed to bite but didn't even bark loudly enough to wake up …