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Doody's Review ServiceReviewer: 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.