Health Flashcards
klein 2006
blair pledged to increase nhs spending at record rate to eu average
the policy of increasing targets and centralisised targets was somewhat in tension with encouraging a diversity of providers - national standards aimed to end postcode lottery
dyer 2006
under new lab it no longer mattered who provided health on behalf of nhs as long as it was free at point of use and high quality; a gp surgery for nhs patients run by a private commercial company opened in 2006
1974 nhs reorganisation
administrative reorganisation, from tripartite system to more centralised form of management at regional and area level
1989 ‘working for patients’ white paper
introduction of nhs internal market and quasi-market - splits purchasers and providers of care. there is now a state funded internal market. gp fundholding, which gives gps budgets to buy care on their patients behalf is introduced. for first time, nhs is truly a nationally administered, centralised service – klein
1997 new labour health reforms
formally abolish nhs internal market and gp fundholding - some gp’s were pursuing own interests
but maintain main parts of the internal market as maintain separation between purchasers and providers, introduce pct’s where managers spend local health budgets. continued private sector provision in the nhs, and pfi’s - using commercial money to build and maintain nhs hospitals.
increased nhs spending under blair
from 5% gdp to 8% gdp
85000 more nurses and 32000 more doctors.
nhs direct.
private sector involvement in nhs under blair
more than doubles to 4.4%
what matters is what works
winter crisis of 1999 exposes flaws of nhs, need more private sector and pfi’s to meet demand exposed
new labour health regulation
introduced nice, chi, waiting list targets
ensure higher national standards and less of a postcode lottery. waiting lists down half a million.
willsford path dependency 1994
big reform is not the norm in healthcare due to the large number of veto players and the number of veto points in many political systems
uk is easier to reform than us as strong executive, large majority governments produced, centralised and hierarchial nhs structures easier to reform than a fragmented us healthcare system. when there is sufficient willpower and ‘conjectures’; radical reform is possible
nhs was created in unique mood of social change post ww2
thatcher’s radical nhs reforms of internal market were possible as she had high ratings after election, a perception nhs was in crisis from voters, and divided medical profession/bma had bad rep. a year later it would have not been possible due to her weakened position
us is harder to reform as many branches have power, more veto points and players, already a fragmented system in hands of man providers. the clinton presidency set out to introduce insurance based system, but was blocked. obama only possible as democrat control of congress, and still had to go to supreme court; heavily watered down along the way
what is path dependency?
a sequence of political changes tied to previous decisions/existing institutions as structural forces end up dominating and preventing transformative change, and the status quo triumphs
immergut 1990
the power of the medical profession; what matters is not their levels of unionisation but the veto points which exist in the political system that they can use to block reform
switzerland: direct democracy meant medical lobby could easily block reform and use disproportionate force, they called a referendum to stop reform and ended up with very minimal healthcare programme
france: 40-60% unionisation an introduced a social insurance health system, legislature had most power so lobby could target individual members to undermine majority, but constitution of 5th allowed exec to overrule – though reforms were watered down a bit
sweden: most unionised medics of all 3, but built most comprehensive health system - an nhs with doctors employed by the state, this is due to lack of veto points in sweden’s political system
le grand 1998
since the introduction of an internal market, rate of growth of nhs output has increased; but it is difficult to judge the impact of reforms as lack of independent assessment and can’t tell if rising investment or reform is cause
ham 2014
clear evidence that targets and performance management contributed to improvements in nhs performance under new lab; major waiting time falls and reductions in healthcare acquired infections, improvements in areas of clinical priority like cancer and cardiac
– but some evidence of gaming and misreporting to avoid penalities and sanctions of targets culture
what is efficiency in nhs ?
extent to which time, effort or cost is well used for intended task or function
hard to tell what reforms or increased spending is responsible for what as both have happened at same time, as well a other expansions in welfare state
has healthcare reform helped the quality of healthcare?
waiting times declined under new lab and increased under coalition so unsure
choice benefits middle class
corners cut and uneven care quality
satisfaction rose to 1990 after reforms, then fell until new labour and up to highest level (british social attitudes survey)
