Authors: Geoff Easton; Malcolm Poad
In 1991 the UK government of the day changed the way in which some of the funding for the National Health Service was administered. They introduced a measure of marketisation into the process. Prior to 1991 the funding of both primary and secondary health care had been on a distributed allocation basis. After 1991 a partial purchaser – provider split was created. In 1998 the new Labour government fulfilled their election pledge and abolished what came to be known as GP fundholding. Thus this period from 1991 to 1995 in the UK can be regarded as an experiment in using market processes to manage health care. The case study reported in this paper is based upon the Bradford Hospitals Trust. It draws on a wealth of very detailed hospital data on admissions etc as well as formal qualitative interviews and continuing day to day contacts between one of the authors and the GP Fundholding practices within the area. There were 4 main types of change in the relationships between GP fundholders and the Bradford Hospital Trust during the marketisation experiment. GP fundholders moved referrals to competitor hospitals, reduced demand on the Bradford Hospital trust, persuaded the hospital to run outreach clinics and used contract mechanisms to reduce prices and improve services. In order to explain these changes a three component model, dyad, network and contingencies, was developed. The paper concludes by arguing that regulation of the marketisation process meant that GP ? hospital relationships were largely transactional but within a highly regulated hierarchy.
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Publish Year: 2003
Conference: Lugano, Switzerland (2003)