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June 1996 (Volume 74)
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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.
Author(s): Chris Ham
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Volume 74, Issue 2 (pages 191–214) Published in 1996
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.