Although information on variations in health service performance is now more widely available, relatively little is known about how healthcare payers use this information to improve resource allocation. We explore to what extent and how Primary Care Trusts (PCTs) in England have used the NHS...

In the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into...

Third party payers for health care, when introducing policies to promote equity, through formulas for resource allocation by capitation, and efficiency, through prospective payment by case-mix, have sought to make adjustments for “unavoidable” hospital costs, which are caused by structural...

This paper examines problems of setting targets for health care performance in which the centre sets a uniform set of targets and levels of performance. The case study examined by the paper is from the system of performance assessment of ‘star ratings’ that was introduced from 2001...

Improving accountability in public services has been a central objective of many public sector reforms in recent years. Chief among these have been efforts to generate observable performance measures as a basis for monitoring performance. This paper examines a natural experiment in regimes...

The World Bank's Global Burden of Disease Study pioneered the use of Disability Adjusted Life Years (DALYs). In this paper we distinguish between the total and the “avoidable” burden of disease. We identify different ways of measuring DALYs: incidence‐based DALYs are appropriate where the...

Prior to devolution in 1999, governance of schools and hospitals in England and Wales was similar. After devolution, the funding and organization continued to be similar, but the two governments adopted different policies in the pursuit of common objectives. This paper reports the results of two...