title: Ditching the single-payer system in the national health service: how the English Department of Health is learning the wrong lessons from the United States.
abstract: Reforms to the British National Health Service introduce major changes to how health care will be delivered. The core elements include the creation of new purchaser organizations, Clinical Commissioning Groups, which unlike their predecessors will be able to recruit and reject general practices and their patients without geographical restriction. The Clinical Commissioning Groups are to transition from statutory bodies to freestanding organizations, with most of their functions privatized and an increasingly privatized system of provision, In this paper, we explore the likely consequences of these proposals, drawing in particular on the experience of managed care organizations in the United States, whose approach has influenced the English proposals extensively. We argue that the wrong lessons are being learned and the English reforms are likely to fundamentally undermine the principles on which the British National Health Service was founded.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Reynolds
authors.forename: Clare
authors.initials: C
authors.lastname: Gerada
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
mesh_terms: D018166:Health Care Reform / Q000191:economics*; D006801:Humans; D008329:Managed Care Programs / Q000191:economics*; D009310:National Health Insurance, United States / Q000191:economics*; D018855:Single-Payer System / Q000191:economics / Q000458:organization & administration*; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom; D014481:United States