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Will primary care trusts lead to US-style health care?

BMJ 2001; 323 doi: (Published 04 August 2001) Cite this as: BMJ 2001;323:281

The NHS is probably safe in the government's hands

  1. John Appleby (, director, health systems programme
  1. King's Fund, London W1M 0AN
  2. Health Policy and Health Services Research Unit, School of Public Policy, University College London, London WC1H 9QU
  3. School of Accounting and Finance, University of Manchester, Manchester M13 9PL
  4. Health Policy and Health Services Research Unit, University College London

    EDITOR—Pollock has presented a one sided view and explanation of some of the policy actions she suggests may drive the NHS towards a US-style health care system.1 Her view is that, as a result of a combination of historic and current policy changes, NHS trusts will be burdened with such large debts that they will be forced to embark on several actions that will raise “the spectre of US-style health maintenance organisations.”

    But her initial premise (of rising cost pressures) is a bit wobbly.

    Firstly, although capital charges do indeed represent a cost to trusts in the NHS, these are not new. Introduced as part of the internal market, they were matched on the purchasing side so that the net sum across the NHS was zero.

    Over time, the direct link between an individual trust's charge and the compensating money given to its purchasers has been broken. Providers have had to think more carefully about their use of capital. Overall, this is a good thing as capital, like labour, is not a …

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