Planning, Markets and Hospitals

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Overview

"Improving access to hospital services has been a goal of public policy in Britain for over seventy years, but the means by which this goal is to be attained have changed significantly over time. Drawing substantially on original research, Planning, Markets and Hospitals represents a systematic attempt to assess the strengths and weaknesses of different forms of planning and coordination of hospital development." The book encompasses an era which began with a mixed economy of hospital provision in the inter-war period, incorporating some embryonic public-private partnerships. There ensued, after 1948, a period of hierarchical planning, symbolised by the 1962 Hospital Plan. Frustrations with the problems of implementing this Plan led ultimately to the re-emergence of pro-competitive solutions to hospital development, exemplified by the 1991 NHS reforms and the subsequent Private Finance Initiative. Despite these important changes, however, the book shows that there were also substantial continuities in terms of regulatory and steering mechanisms in the hospital service.
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Editorial Reviews

Doody's Review Service
Reviewer: Richard L. O'Brien, MD (Creighton University)
Description: The author provides a critical historical analysis of hospital planning and regulation in the United Kingdom from before World War II (WWII), through centralized planning under the National Health Service (NHS), the 1991 NHS reforms, to the present.
Purpose: The stated intent is to compare various forms of governance and planning and to determine, if possible, which have been more and which less successful in providing equity and access to care.
Audience: This work is useful for health planners, policymakers, politicians, and students of health policy and social justice.
Features: Prior to WWII, most hospital services in the U.K. were provided by voluntary hospitals, with some early efforts at public/private partnerships to ensure access. Centralized hierarchical planning under the NHS, initiated in 1948, ultimately resulted in the 1962 Hospital Plan. Lack of political will and capital commitment resulted in slow implementation and several changes in direction. By 1991, the number of hospitals in the U.K. had declined by more than 40 percent. A conservative government and public dissatisfaction culminated in implementation of NHS reforms that decentralized governance of hospital services. Funding was allocated as regional global budgets and regional authorities contracted for and purchased services in a competitive market.
Assessment: The analyses of the interplay of politics, cost, and technological change on planning, funding, and regulation are of considerable value to policymakers and politicians. The author points out that various hybrids of central planning and market forces (with one more or less dominant) have been attempted. He explores the shortcomings of both centralized planning and market forces. This valuable analysis can only lead one to conclude that a design that provides services equitably, constrains costs, and satisfies public desire for access has not yet been found. This well-referenced book is organized chronologically. A concluding chapter provides an excellent summation.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780415196062
  • Publisher: Taylor & Francis
  • Publication date: 7/26/2002
  • Pages: 288
  • Lexile: 1550L (what's this?)
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.81 (d)

Table of Contents

1. Planning Markets and Welfare: Debates about Hospital Policy and the Welfare State 2. Legacies, Donations and Municipal Priorities: The Evolution of the British Hospital Services Prior to 1948 3. Regionalism: A Positive or Negative Consensus? 4. Wartime Hospital Policy: Attractions and Limitations of Public-Private Partnerships 5. The Absence of a Capital Programme, 1948-59 6. Explaining and Reappraising the 1962 Hospital Plan 7. From 'Plan' to 'Programme', 1962-73 8. A Programme Without Policy? Hospital Developments 1973-91 9. Hospitals After the 1991 Reforms: Markets, Hierarchies or Networks? 10. Conclusions
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