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REFORMING THE NHS IN THE 1990s SUCCESS OR FAILURE The health care system of many countries throughout the developed world are being reformed and restructed In the current ferment of change and experimentation the British Health service is in the forefront A pioneering concept in 1948 the NHS remained the prime example of a centrally planned and funded public health servive In 1990 it again pioneered a new model of organising and delierening health services By the late 1980s the NHS was suffering from a severe lack of resouces This was the result of three factors Firstly becouse of the policies of the government which was cutting back on public expenditure Secondly becouse of the increasing numbers of elderly with their demands on the health services and thirdly the increasing demands for higher standards of health The situation was so bad that districts were not paying their bills and operations were being cancelled Waiting lists were increasing rapidly As a result a review of the NHS was announced The Government Review produced a list of the strengths and weaknesses of the NHS and suggested that one of the main problems lay in the lack of incentives for emploees of the NHS to make savings and be more efficient The government was strongly influenced by an economist Enthoven who argued that by introducing an internal market to the NHS managers would be encouraged to become more efficient and without extra spending many of the NHS could be solved He claimed that there is nothing like a competitive market to motivate quality and economy of service Carrier 1998 p145 What Enthoven meant by the internal market was that each hospital or community care unit would compete against others to win contracts to care for specified numbers of patients This is similar to the situation faced by companies in the private sector of the economy which compete against each
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