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At least 73 records · Page 4Linked to original sources
PubMed1994

Is health care a commodity: how will purchasing improve the National Health Service?

Through the reforms to the National Health Service in 1990 an internal market for public health care provision in the United Kingdom was introduced. As part of this new system of care, responsibility for purchasing of health care was separated from that for its provision. The new purchasing function, undertaken by district health authorities and fundholding general practices, has created the opportunity for improvements in health and higher standards of care to be achieved through new and explicit mechanisms. However, the purchasing function has not yet realized its full potential to achieve beneficial change, partly because traditional behaviours have not yet adapted to the new system of care and partly because specific aspects of the internal market are creating barriers and perverse incentives. This paper discusses these issues and identifies the important barriers which have still to be overcome if purchasing is to be the driving force for change in the new National Health Service.

Contract Services↗
PubMed1997

Status and development of critical incident stress management services in the United Kingdom National Health Service and other emergency services combined: 1993-1996.

Surveys conducted amongst members of the Association of NHS Occupational Physicians indicate few changes in the status and development of Critical Incident Stress Management Services (CISMS) in the United Kingdom National Health Service between 1993 and 1996. Limited CISMS are confirmed by the majority of respondents in the two surveys with developments having typically occurred within long-established staff care services such as counselling. In 1996 NHS provision is typically based on the independent use of own resources. A 1996 comparison of NHS with pooled returns from Ambulance Services, Fire Brigades and Social Services Departments indicates few variations in status, provision and levels of expertise in the delivery of CISMS. Other emergency services co-operate to a greater extent with each other than does the health care sector. Occupational Health Department responders confirm availability of expertise resources to provide CISMS, but low priority status frustrates delivery of CISMS. Survey results indicate the NHS is at risk of not fulfilling its duty to care for staff after major incidents. The establishment of regional centres of CISMS excellence with local and national responsibilities is advocated.

Ambulances↗
PubMed1979

Pricing, insurance and the National Health Service.

Since the birth of the National Health Service in 1948 there have been periodic discussions of the potential role of pricing and insurance in the United Kingdom health care system. This article is concerned with discussing the problems inherent in these mechanisms and it advocates more careful articulation of the cost and benefits of such policies. The first section gives a description of some quite recent proposals to extend the role of the pricing and insurance mechanisms which have been made by the British Medical Association and the McKinsey consultancy company. The second section uses economic analysis to show that both the pricing and the insurance mechanisms have inherent problems which may vitiate their efficiency in many western health care markets. The third section is concerned with the mechanisms by which the efficiency of the health care system can be improved, and radical experimentation is advocated. Without radical experimentation and the implementation of suitable incentive systems, inefficiency and inequality will continue in the National Health Service.

Economics, Medical↗
PubMed2006

Government reform of the National Health Service: implications for radiologists and diagnostic services.

Demand for radiology services within the National Health Service (NHS) continues unabated and current NHS operations cannot keep up with demand. Therefore, to meet this demand, the government has decided to outsource a significant number of investigations to the independent sector and will actively promote patient referrals to the new government sponsored Treatment Centres as they become available. This presents opportunities to patients, but threatens existing public sector providers (including doctors) as competition for radiology services may result in both loss of patient referrals and revenue to these providers. This article is a personal opinion and will focus on the current challenges facing the provision of radiology services in the NHS. I will suggest the possible negative outcomes for providers (NHS hospitals and staff alike) and will offer strategies, tactics and tools that can be employed to counter the threat to their existing services.

Diagnostic Services↗
PubMedDate not supplied

[Role of specialized care services of the national health service in the framework for the prevention of occupational risks (II)].

INTRODUCTION: Since 1986, the Government of Navarra has taken over the functions of security and health as part of the health 'area', with a broad conception of health, avoiding separating the citizen from the worker. In 1993, the Instituto Navarro de Salud Laboral created, under the direction of the departments of Health and Labor, combined diverse functions and resources, integrating preexisting structures into a technical department to be responsible for the overall health care of workers. DEVELOPMENT: The structure is based on two coordinated pillars, security and hygiene at work and occupational health. As more specifically to do with health, we describe the systems of epidemiological information and vigilance and programs for occupational disabilities, health activities in industry and investigation of diseases. The Unidades de Salud Laboral link the workplace with the public health service. The occupational health plan of Navarra will set out future strategies. CONCLUSIONS: It is necessary to involve neurologists in occupational health. Occupational risks and injury are everyone's problem. The neurologist's role in accidents is usually of health care; detection of illness is more difficult when an occupational relationship is not considered. Data from work should be included in the clinical history. The official figures for occupational neurological diseases are ridiculous and more cases should be detected. There should be a fluid relationship between neurologists, occupational doctors and experts in prevention.

Humans↗
PubMed1975

The 1974 reorganization of the British National Health Service: an analysis.

The British National Health Service was reorganized on April 1, 1974, for the first time since its formation in 1948. The Reorganization attacked one serious problem: the anomalous separation of the general practitioners (and other nonhospital, non-local authority ambulatory services), hospitals, local government authority public health services, and teaching hospitals into different administrative units with different boundaries. These services are now integrated into one structure. However, other important problems will not be affected substantially.

Community Participation↗
PubMed1982

Resource consumption and future organisation of medical work in the National Health Service.

Medical expenditure within the National Health Service (NHS) is based upon an arrangement whereby doctors share in common resources provided by the Health Authority. This arrangement is unsatisfactory when resources are contracting and leads to social regulation of medical activity. If doctors within the district work-group do not response to the challenge of cost-containment by internal organisation, more and more externally imposed regulations will result to the detriment of patients and doctors. The continual redevelopment of organisation to permit the optimal mix of internal and external regulation should be a subject of long-term enquiry and action for doctors in each district.

Costs and Cost Analysis↗
PubMed1976

The Isis Centre: a counselling service within the National Health Service.

A new centre has been established to provide readily accessible counselling, consultation, and mental health information. People may refer themselves or are recommended to attend by general practitioners or other agencies. The counsellors have varied backgrounds in paramedical or counselling services, and they are supported by psychiatrists. Of a sample of 100 clients, four were referred to one of the team's psychiatrists and 33 visited the centre only once. The centre's staff aim to adopt a flexible approach to the client and his problems, and formal psychiatric categories have not been found useful. Provision is made for people who want to solve their problems by discussion rather than medication and those for whom the existing psychiatric services may have little time to spare. Consequently, the approach adopted by the Isis Centre, whereby many people benefit from psychotherapy yet the psychiatrist deals directly with only a few selected cases, contributes towards meeting the great need for psychiatric services and using the psychiatrist's skills more effectively.

Adult↗