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At least 19 recordsLinked to original sources
PubMed1980

Public Health Service--National Health Service Corps Scholarship Program. Final regulations.

These regulations set forth the requirements for the award of scholarships under the National Health Service Corps Scholarship Program to students receiving academic training in medicine, osteopathy, dentistry, and other health professions in order to assure an adequate supply of trained health professionals for the National Health Service Corps.

Eligibility Determination↗
PubMedDate not supplied

Ordering social objectives: National Health Service and National Health Insurance as policy options in organizing the medical care system.

For many years, a sharp distinction was made between NHS and NHI on the basis of payment and program focus. First, NHS was defined as a program essentially based on Congressional appropriations (general revenues); while NHI would be based on premiums largely derived from the insured. Second, NHS guaranteed service while NHI guaranteed only payment for services rendered.The distinctions were later extended from these definitions to include differences in response to resource needs, changing task descriptions and personnel assignments, more equitable redistribution of manpower, centralized administration and consumer participation.In general, if the goal were equity, NHS seemed more responsive than NHI.However, in recent years, the approach to NHI has been modified in response to criticism as well as increasing recognition of changed needs, and proposals for NHI like the Kennedy-Corman bill have become more like proposals for a NHS. In short, the difference today is largely one of immediate as against eventual transformation of the medical care system into a social instrument aiming to achieve equity. The major disagreement is whether the present medical care system lends itself to modification so as to achieve that end.

Community Participation↗
PubMed2004

Charging for NHSPlus: an inferential study based on the internal provision of occupational health services within the National Health Service.

BACKGROUND: 'NHSPlus' was conceived as a national agency that would provide occupational health services to organizations, for a fee, without imposing any financial burden on the taxpayer. This self-funding requirement brings into focus the resource implications for such a service and the determination of the charges to be made to external clients. AIM: The existing provision of occupational health services to >100000 National Health Service (NHS) staff by 13 NHS occupational health services of various sizes was analysed, with the objective of determining an appropriate charge-out rate to third parties. METHOD: Two focus groups were questioned on their work external to the NHS. Data collected on the allocation of doctors and nurses to occupational health services in relation to the number of NHS clients serviced were used to investigate the nature of the resourcing relationship using regression analysis. RESULTS: The relationship was found to be stable enough to provide a good estimate of staff requirements (the key resource requirement). Combining this with costing information allowed inferences to be drawn concerning the economic cost and hence the break-even rate of charge for the service. This was then compared with the employer charge rates in the NHSPlus published case studies. CONCLUSIONS: The results suggest that the per capita charges to external clients are lower than the per capita cost of internal occupational health provision within the NHS, raising questions about the viability of the service.

Fees and Charges↗
PubMed1995

In practice: the NHS market in the United Kingdom. Health Policy Network of the National Health Service Consultant's Association and the National Health Service Support Federation.

The National Health Service provides (and throughout its lifetime of nearly 47 years has provided) comprehensive health care of the highest professional quality at both primary and specialist levels and at very low cost whether expressed in terms of GDP or cash when compared with other industrialised countries. Until the NHS market was introduced, administrative overheads were also strikingly low, between 5% and 6% compared with at least 22% in the US. The legislation imposing the NHS market represents a fundamental reorganisation and fragmentation of the NHS into competing services with a new bureaucracy of business and financial managements topslicing funds for patient care. It is the latest of a number of reorganisations dating from the first plans published by the Conservative administration in May 1971. Our calculations show that the newly imposed market processes have doubled the administrative running costs of the NHS. This represents an additional administrative expenditure of at least I.7 billion pounds a year at current prices. This sum therefore represents a diversion of 1.7 billion pounds a year from clinical services and goes some way to explaining the criticism from clinicians and the delays and inconvenience experienced by the public despite government claims that more money is being spent on the NHS. We describe the clandestine origins of the NHS market and note good and bad effects of its introduction. Because of their serious implications, we describe eleven damaging side-effects. These include the conflict between strategic planning of care and the operation of market forces. We identify other side-effects that are considered to be inseparable from market operation and sufficiently serious to call for urgent redress. We suggest how good effects associated with the introduction of the NHS market (such as giving GPs more say in the development of hospital services) could be enhanced without the side-effects inherent in the NHS market. We urge that ways of addressing these issues should, whenever possible, be piloted before they are introduced nationally. (In the case of fundholding in general practice, this damaging and controversial change should be halted and ways found to replace it with consortium commissioning, for which there is relevant experience.) We discuss the need to halt any other fundamental and potentially destabilising reorganisation before it has been tried out in properly evaluated pilot schemes. This should not, however, be allowed to become a recipe for stagnation as the health policy of the next government.

Economic Competition↗
PubMed1990

Research, policy, and the National Health Service.

The National Health Service is a system designed to bring about a rational use and distribution of resources yet which largely ignores the contribution of the research community. With a relatively closed health policy arena, there are few customers for policy-oriented research. With responsibility for funding research concentrated at the center and responsibility for delivering services at the periphery, the research community finds itself in limbo. In comparison to both the U.S. and Canada, Britain therefore offers an example of research both underfinanced and undervalued. However, research has made some significant contributions in areas where there has been a perceived use for its findings to support service developments. And the changes now being introduced in Britain's NHS are likely to create a new market for research as the system adopts some North American ideas and becomes less consensual and more pluralistic.

Health Policy↗
PubMedDate not supplied

Competition in the British National Health Service.

British National Health Service reforms seek to maintain the right to health care regardless of ability to pay. They involve internal market disciplines, including competition, though services remain free at the point of use. Hospitals, with greater independence, will concentrate on acute care. Family doctors and community health services get wider responsibilities and direct access to funds. Individuals are encouraged to adopt healthy lifestyles.

Economic Competition↗
PubMed1999

Models of commissioning health services in the British National Health Service: a literature review.

The commissioning of health services is an under-researched area and yet it is critical to the way services meet health needs and to the quality of care. Recent emphasis in the United Kingdom and elsewhere has been on a 'primary care led National Health Service', particularly on locality commissioning through primary care groups. However, there are other models of commissioning using 'programmes of care' (focused on diseases or patient groups rather than geography) which may offer greater benefits. There is little research comparing the benefits and costs of these models, and most are not even clearly enough described to be replicated. There will always be a political dimension to models of commissioning, dependent, for example, on the balance of power in the decision-making process. None the less, a broader knowledge of possible models and a willingness to evaluate rigorously are needed if commissioning of health services is to result in better patient care.

Health Care Reform↗
PubMed1997

Paradoxes of GP fundholding: contracting for community health services in the British National Health Service.

The expansion of GP fundholding (GPFH) is central to the British government's attempt to maintain the revolution under way in the National Health Service (NHS). Evaluations of the NHS reforms have portrayed GPFH as an important mechanism for competition, and GPFH's bargaining power is reported to have secured significant changes in health service provision. However, these developments have been acknowledged to be less applicable in relation to community health services (CHS) than acute hospital services. On the basis of case studies of the process of contracting for CHS, GPFHs are shown to display ambivalent and sometimes contradictory views which have to be related to broader policy developments in general practice and primary care. Although this paper focuses on the British situation, many of the issues raised by reforms in primary and community health services have implications for developments in other Western health care systems.

Attitude of Health Personnel↗
PubMed2005

Quality, innovation, and value for money: NICE and the British National Health Service.

The National Institute for Health and Clinical Excellence (NICE) was established as a part of the British National Health Service in 1999 to set standards for the adoption of new health care technologies and the management of specific conditions. In doing so it was required explicitly to take into account both clinical effectiveness and cost-effectiveness. This article describes how NICE has responded to the challenge and considers whether its experience of balancing quality, innovation, and value for money holds policy lessons for the United States.

Academies and Institutes↗