In recent years there have been marked changes in organisational structures and budgetary arrangements in the English National Health Service, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and hospitals. We show that elective...

The English NHS has introduced a system of budgets for general practices covering hospital expenditure for the patients on their lists. We model individual expenditure using diagnostic information from previous hospital spells, plus a large set of attributed variables measuring population,...

Under the UK fundholding scheme, general practices could elect to hold a budget to meet the costs of some types of elective surgery (chargeable admissions) for their patients. It was alleged that patients of fundholding practices had shorter waits for elective surgery than the patients of...

In many health care systems primary care physicians act as 'gatekeepers' to secondary care. We investigates the impact of the UK fundholding scheme under which general practices could elect to hold a budget to meet the costs of elective surgery for their patients. We use a differences in...

Integrated care is often perceived as a solution for some of the major challenges faced by health and social care systems. In these systems, 20% of the population accounts for 80% of the expenditure on care [1]. These ‘high users’ are typically people with one or more long-term...

The election of the Labour government last year shifted the issue of inequality in health to the top of the policy agenda. In its White Paper on the “New NHS”, promises were made about reducing unacceptable variations in services and ensuring fair access. Publication of the Green Paper...

Arguments are being made more frequently to incorporate economic evaluations and quality of life assessments into clinical trials. Using two randomised, multicentre trials of radiotherapy for cancer as an example, this paper outlines: (1) the importance of including such assessments; (2) the...

The optical services market has been altered substantially by government legislation over the past six years. Further deregulation has been proposed which would alter the content and structure of the eye test, resulting in a two-tier test. This would split the refractive sight test, aimed at...

The use of postmenopausal hormone replacement therapy (HRT) has received much attention both in the medical and lay press in recent years. There is considerable pressure to extend the use of HRT both as a method for relieving the distressing symptoms of menopause and also as a prophylactic...