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Related Experiment Videos

Making the internal market work: a case for managed change

L Moore1, M Dalziel

  • 1London School of Hygiene and Tropical Medicine.

BMJ (Clinical Research Ed.)
|November 13, 1993
PubMed
Summary
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The NHS internal market aimed for competition and efficiency. However, a local ophthalmology unit faced challenges due to imperfect market conditions, ultimately improving after collaborative funding and service standard improvements.

Area of Science:

  • Health Services Research
  • Health Economics
  • Ophthalmology

Background:

  • The National Health Service (NHS) internal market was designed to foster competition among provider units based on price and quality.
  • This system aimed to direct funding towards efficient healthcare providers.
  • However, the practical application of market principles in healthcare settings can yield unintended consequences.

Purpose of the Study:

  • To examine the impact of market dynamics on a local ophthalmology unit within the NHS.
  • To illustrate potential pitfalls when entrepreneurial activity interacts with an imperfect healthcare market.
  • To analyze the consequences of short-term market decisions on long-term patient services.

Main Methods:

  • Case study analysis of a specific NHS ophthalmology unit.

Related Experiment Videos

  • Examination of pricing, workload, and waiting times.
  • Investigation of purchasing decisions by fundholders and district health authorities.
  • Assessment of stakeholder responses (GPs, purchasers, provider unit) to service viability issues.

    • Main Results:

    • An ophthalmology unit with high workload and prices experienced increased waiting times and GP dissatisfaction.
    • Failure to fund a necessary third consultant post led to contract withdrawal by neighboring fundholders.
    • Despite financial and clinical viability concerns, patient demand persisted.
    • Collaborative funding and establishment of service standards by local stakeholders led to reduced waiting times and improved service quality.

    Conclusions:

    • Imperfect market conditions can negatively impact healthcare services.
    • Short-term market-driven decisions may have unforeseen long-term implications for patient care.
    • The case highlights the need for careful consideration of market mechanisms within the evolving NHS structure.
    • Stakeholder collaboration and clear service standards are crucial for successful healthcare provision.