Finance and Delivery of Health Care
| Author | Allan Bruce |
| DOI | 10.1177/014473949401400105 |
| Published date | 01 March 1994 |
| Date | 01 March 1994 |
Teaching Public Administration: Spring
1994,
vol. XlV,
no.
1,
pp. 49-63
Finance
and
Delivery
or
Healtb
Care
ALLAN BRUCE
Department
of
Law
and
Public Administration, Glasgow Caledonian University
INTRODUCTION
The National Health Service (NBS) became operational in July
1948
and has
subsequently enjoyed a considerable amount
of
popular support. Indeed,
of
Britain's
welfare institutions, the NHS has consistently demonstrated itself to
be
the most
popular with the electorate
as
a whole, a feature which may in part have thwarted or
at least delayed the prospect
of
more radical reform. Broadly speaking, the NHS was
created to make a comprehensive range
of
health services available to the entire
population, irrespective
of
income and wealth. These services were at the outset to be
paid for out
of
general taxation and were to be available largely free at the point
of
consumption
(I).
More recently, however, while there has been some attention devoted
to identifying supplementary or alternative sources
of
funding
for
the NHS (Bruce and
Bailey, 1993), the Government remains committed to an
NHS
that 'will continue to
be
open to all, regardless
of
income, and financed mainly out
of
general taxation'
(Department
of
Health, I 989a).
In some senses, the NHS may have avoided the worst effects
of
the 'privatisation bug'
that has been prevalent within the welfare sector, though this is not to say that it has
escaped moves towards increased commercialisation. The introduction
of
general
management, resource management, performance indicators, contracting out and a new
contract for General Practitioners (GPs) were all key components
of
a cultural change
that was promoted within the NHS during the
1980s.
A main plank
of
the
Government's ongoing strategy
for
the
NHS
in the 1990s is to encourage competition
between providers
of
health
care.
In its previous incarnation, the NHS had been protected
from
the effects
of
competition
and seemed to be dominated by the influence
and
restrictive practices
of
the medical
profession. Moreover, there was an absence
of
financial incentives to encourage the
NHS to do better and there was an absence
of
initiatives to encourage consumer
involvement and choice in the provision
of
health
care.
All
of
this was echoed in a
familiar theme
of
the Government throughout the 1980s and into the 1990s in its
dealings with the public sector, that there was a need to encourage increased emphasis
upon the virtues
of
efficiency, effectiveness and economy.
49
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