title: Lessons from London: the British are reforming their national health service.
abstract: In an effort to keep abreast of the changing needs of a more affluent society and to ensure better value for money, the British are reforming their National Health Service. They are promoting competition and entrepreneurship, and directing funding to follow a patient rather than flowing directly to institutions. British physicians are resisting these changes. The United States, in the middle of a health care crisis of its own, can learn a great deal from Britain, especially in the area of controlling expenditures. The low cost of the National Health Service can be attributed to four major factors: (1) It is general practitioner driven and no patient accesses a specialist or hospital directly. (2) Hospitals, which employ all the specialists and supply most of the technology, operate on very tight, cash-limited budgets. (3) Administrative costs are very low. (4) The expense of malpractice is not (yet) a major concern. Changes occurring in both countries foretell a future wherein our health care systems may look very much alike.
authors.affiliation: School of Medicine, University of New Mexico, Albuquerque 87106-4977.
authors.forename: A
authors.initials: A
authors.lastname: Vall-Spinosa
mesh_terms: D003363:Cost Control; D004465:Economic Competition; D004503:Education, Medical, Graduate / Q000458:organization & administration; D016520:Entrepreneurship; D005194:Family Practice / Q000458:organization & administration; D015276:Health Care Rationing; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008318:Malpractice; D008511:Medicine / Q000458:organization & administration; D010820:Physicians / Q000523:psychology; D011332:Privatization; D011639:Public Opinion; D013038:Specialization; D013222:State Medicine / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D006113:United Kingdom; D014850:Waiting Lists