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Biomedical subjects

C Ham

Publications and source records attributed to C Ham.

At least 19 recordsLinked to original sources
PubMed1996

Population-centered and patient-focused purchasing: the U.K. experience.

A critical feature of the reforms to the National Health Service (NHS) in the United Kingdom is the separation of responsibility for purchasing and providing health care. In the new structure, health authorities purchase care from a population perspective, and general practitioner fundholders undertake patient-focused purchasing. The evidence suggests that each approach has distinctive advantages. There is, however, a risk of fragmentation if the decisions of the different types of purchaser are not coordinated. This risk is compounded by the emergence of hybrid models combining aspects of population-centered and patient-focused purchasing. The separation of purchasing from providing has changed the balance of power within the NHS, although whether the benefits of the new system outweigh the costs is a matter of continuing debate.

Contract Services↗
PubMed1995

Synthesis: what can we learn from international experience?

International experience shows that rationing can occur through exclusions or through the use of guidelines. Oregon has chosen to ration by excluding certain services in order to move towards universal population coverage. New Zealand has avoided exclusions and has chosen to ration through the use of guidelines. The Netherlands is pursuing both approaches. The experience of these and other countries demonstrates that rationing is inherently difficult. Choices in health care can be informed by techniques drawn from economics and other disciplines but these techniques need to be used as part of debate and discussion in the process of arriving at decisions. Experts and the public can contribute to this process and strenuous efforts need to be made to ensure participation by a representative cross-section of the population. At its root priority setting is a political process shaped by beliefs and values. Increased transparency in decision making should promote greater accountability and increased public awareness of the nature of rationing.

Health Care Rationing↗
PubMed1994

Managing the NHS market.

The purpose of the present NHS reforms is to introduce a managed market; developing some of the incentives for greater efficiency that are often found in markets while still being able to regulate proceedings to prevent market failures. If government intervenes too much there will be no incentive to improve efficiency and streamline operations: too little intervention may result in some areas having inadequate health service cover or monopoly powers abusing their position. Effective management of the NHS market requires eight core elements: openness of information, control of labour and capital markets, regulation of mergers and takeovers, arbitrating in disputes, protection of unprofitable functions such as research and development, overseeing national provision of health services, protection of basic principles of the NHS, and handling of closures and redundancy. Management of the market would best be performed by the NHS management executive and health authority purchasers acting within a framework set by politicians.

Economic Competition↗