Reforming the UK health care system: as framework for analysis and a review of some recent proposals

As a contribution to the current debate on the future of the NHS, this paper sets out a framework with which proposals for reform can be analysed. Eight different proposals are classified according to their dominant methods of finance and provision of health care. Criteria are then developed by which the proposals can be evaluated, covering issues of efficiency, equity and consumer choice. A checklist of questions is addressed to each option (the detailed results of which are attached to Appendix 1) to determine the mechanisms by which beneficial change is to be brought about, and to identify the evidence available as to whether these mechanisms would be successful. The conclusion is that there is very little hard evidence to support the claims in the various proposals. More experimentation and evaluation is required to produce this before major change is contemplated. What the approach does demonstrate is the difference in ideological perspective behind the proposals and the need for clear statement of objectives by the proposers of reform before its full implications can be assessed.