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March 1989 (Volume 67)
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The history of the British National Health Service (NHS) over the past decade demonstrates both institutional adaptation and insulation from more basic structural change. Reflecting international trends, the NHS has, on the one hand, recentralized decision making, adopted strong managerialist policies, accommodated a modicum of privatization, and stressed the client’s role in some service choices. On the other hand, the government has skirted introducing unbridled competition into the health service. Assessment of a 1989 “Government Review” highlights the tensions the NHS faces between budgetary pressures and consumer demands, and between centralized controls and medical autonomy, among others.
Author(s): Patricia Day; Rudolf Klein
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Volume 67, Issue 1 (pages 1–34) Published in 1989
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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.