Working the markets: purchaser/provider separation in English health care

In 1991 the U.K. health system embarked upon a series of apparently radical changes in its organization, centering upon the notion of "purchaser/provider separation." After summarizing these changes, and their ostensible rationale, this article reports early experiences of the new system and outlines the alternative proposals of the main opposition Labour Party. Early experience suggests that the new system is unlikely to function as ostensibly intended. The Labour alternative, however, fails to address crucial organizational issues.