The British quasi-market in health care: a balance sheet of the evidence.
OBJECTIVE
To summarise the findings from a comprehensive review of research on the effects of the three main elements of the quasi-market reforms of the UK National Health Service (NHS) introduced in 1991/92: General practices becoming fundholders by volunteering to purchase elective care for their patients; Health authorities becoming purchasers of emergency, unplanned and elective services, together with a range of alternatives to fundholding operating under their auspices; The conversion of providers of hospital and community health services to NHS trusts separate from their local health authorities.


METHODS
Published and unpublished studies which included any data on the impact of the three main planks of the quasi-market changes, produced between 1991 and late 1998, were identified using a combination of electronic databases, library catalogues at the King's Fund, London, bibliographies, reference lists of individual studies, a survey of NHS directors of public health and consultations with subject area experts. Each main element of the quasi-market was assessed in relation to its impact on: efficiency (primarily productivity); equity; quality; choice and responsiveness; and accountability.


RESULTS
There was relatively little measurable change that could be related unequivocally to the core mechanisms of the quasi-market.


CONCLUSIONS
The incentives were generally too weak and the constraints too strong to generate the consequences predicted by either proponents or critics of the quasi-market. On the other hand, the way in which the NHS operates was changed irrevocably by the reforms.
Mays
N
N
Health Services Management Centre, University of Birmingham, UK.
Mulligan
J A
JA
Goodwin
N
N
D002017:Budgets / Q000639:trends; D005194:Family Practice / Q000458:organization & administration / Q000639:trends; D018166:Health Care Reform / Q000458:organization & administration / Q000639:trends*; D006302:Health Services Research; D008389:Marketing of Health Services / Q000458:organization & administration / Q000639:trends*; D009313:National Health Programs / Q000458:organization & administration / Q000639:trends; D009936:Organizational Innovation; D011216:Practice Management, Medical / Q000458:organization & administration / Q000639:trends; D006113:United Kingdom