1 / 18

Can the English National Health Service learn from the Dutch reforms?

Can the English National Health Service learn from the Dutch reforms?. Meeting the medium term challenge of the financing of health & aged care in England 27 January 2011 The Royal Society, London Gwyn Bevan Department of Management, LSE R.G.Bevan@lse.ac.uk.

zahir-best
Download Presentation

Can the English National Health Service learn from the Dutch reforms?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Can the English National Health Service learn from the Dutch reforms? Meeting the medium term challenge of the financing of health & aged care in England 27 January 2011 The Royal Society, London Gwyn Bevan Department of Management, LSE R.G.Bevan@lse.ac.uk

  2. Objectives of health care reforms in OECD countries* 2. Cost control: rationing & expenditure caps    UK from 1990s    3. Performance: incentives & competition  1. Equity: access by need not ability to pay * Cutler (2002) Equality, Efficiency, & Market Fundamentals: The Dynamics of International Medical-Care Reform. Journal of Economic Literature.

  3. Law of requisite variety: 3 goals  3 instruments Cost control Equity Performance

  4. NHS 1980s: 3 goals & 2 instruments Cost control: fixed total budget Below target income: no ‘efficiency’ savings Formula funding  equitable allocations ‘Efficiency’ savings Above target  income: cuts not ‘efficiency’ savings Health authorities run providers

  5. From 1991: purchaser / provider3 goals & 3 instruments Cost control: fixed total budget NHS providers Formula funding  equitable allocations Efficiency by competition Purchasers Private providers

  6. Internal market (1989 -97): Design* • Purchaser / Provider • Provider competition • ‘money follows the patient’ • Selective contracting • health authorities • GP fundholders • (no patient choice) *Working for Patients

  7. Internal market (1989 -97): Impact • Le Grand (1999)* • Little evidence of change • Incentives too weak & constraints too strong • Tuohy (1999)** • NHS logic • Ministerial accountability • Collegial decision making • Poor information on prices & quality * Le Grand (1999) Competition, cooperation, or control? Health Affairs ** Tuohy (1999) Accidental Logics. Oxford University Press

  8. Patient choice & competition (2006 - 10): Design* • Provider competition • ‘money follows the patient’ (PbR) • standard tariff: quality competition • Selective contracting • Primary Care Trusts • World Class Commissioning • Patient choice • Provider diversity • Foundation Trusts & Independent Sector Treatment Centres *Delivering the NHS Plan

  9. Patient choice & competition (2006 - 10): Impact • Failure to create functioning market* • political interference • weak purchasers • barriers to exit & entry • changing policies • reorganisations No * Brereton & Vasoodaven (2010) http://www.civitas.org.uk/nhs/download/Civitas_LiteratureReview_NHS_market_Feb10.pdf

  10. Impact both NHS markets? Overview of literature* • No good evidence reforms produced beneficial outcomes classical economic theory predicts of markets provider responsiveness to patients & purchasers large-scale cost reduction  innovation in service provision • NHS incurs transaction costs of market without benefits? * Brereton & Vasoodaven (2010) http://www.civitas.org.uk/nhs/download/Civitas_LiteratureReview_NHS_market_Feb10.pdf

  11. NHS from 2010? We will stop the top- -down reorganisations of the NHS that have got in the way of patient care

  12. If reorganisation of purchasers is the answer … Population ('000s)

  13. Liberating the NHS: Objectives?* • NHS commissioning board • Steering not rowing? • GP Consortia • GPs involved in shaping services? • Independent providers • Choice & managed competition? • Reorganisation • Evolution not revolution? * Equity and excellence: Liberating the NHS

  14. Reflections: 20 years ofmarket reforms The Netherlands England 5 blitzkriegs (SW1) army of occupation in hostile territory?* Provider competition limited impact Model abandoned New Zealand, Scotland & Wales • 1 agreed policy • Dutch procession of Echternach • MHP competition • as yet little selective contracting • Model exported • Germany & Switzerland *Shock (1994) Medicine at the centre of the nation’s affairs, BMJ

  15. Going Dutch: Provider  Purchaser competition? Cost control: fixed total budget PCT clusters Efficiency by purchaser competition& selective contracting / integration Risk-adjusted funding  equitable allocations Mutual Healthcare Purchasers (MHPs)

  16. Mutual Healthcare Purchasers (MHPs) • Plurality • PCTs / GP consortia • Insurers? Foundation Trusts? • Define catchment areas • Guarantee duty of care • Selectively contract / integrate • Explicit insurance contract • Choice of packages • Restrict choice? Charges?

  17. NHS Commissioning Board: Regulation of MHPs • Entry • key competences & duty of quality • Competition • sufficient numbers & information • Equity • funding & open enrolment • Insurance • solvency & transparency

  18. Can the English National Health Service learn from the Dutch reforms?* Thank you Gwyn Bevan Department of Management, LSE R.G.Bevan@lse.ac.uk * Bevan & van de Ven (2010). Choice of providers & Mutual Healthcare Purchasers: can the English NHS learn from the Dutch reforms? Health Economics, Policy & Law

More Related