THE HEALTH CARE MARKET

1
THE HEALTH CARE MARKET
2
UK PRIMARY HEALTH CARE

• General practitioners employed by the NHS
• Payment to GPs
• number of patients registered
• treatments
• Control over number of patients
• per head of population
• more people more money
• Patient register with local GP
• each has own catchment area

3
WHY CHANGE?

• Inefficient
• need accountability
• No choice
• nearest GP
• No competition
• no pressure
• No encouragement to provide good/extra service
• where else could you go?
• take what youre given

4
POST 1991

• GPs given power over how money is spent
• Removal of barriers to patient transfer
• Hospitals competing with each other for GP
  referrals
• GPs encouraged to compete

5
NEW SYSTEM BETTER?

• Competition between GPs and between hospitals
  means
• better / more services
• choice
• go to GP with better connections
• go to hospital with shorter waiting lists
• efficient
• shorter waiting lists
• no wastage
• good GPs prosper

6
ASSUMPTIONS

• Know about alternatives and can make informed
  choice
• Able to evaluate quality
• Motivated to move

7
KNOW ABOUT ALTERNATIVE ?

• Informed choices?
• service
• heterogenious
• inseperable
• intangible
• lack of experiential knowledge
• cant judge without using
• dependent of local networks
• is your GP good for me?
• treats smokers?

8
ABILITY TO EVALUATE?

• how do you evaluate quality?
• relief/cure
• credence/trust
• delivery/situation

9
MOTIVATION TO MOVE

• Degree of investment
• history
• Lack of comparative experience
• better the devil you know

10
NEW SYSTEM BETTER?

• Have choice but dont exercise it
• GPs not competing
• More services

11
1997

• New Labour - New NHS
• End of internal market
• Cooperation
• hospitals - specialist services
• NHSnet
• Advice and information at home
• NHS Direct
• so that they are better able to care for
  themselves