The internal markets of the British National Health Service: prospects and problems

Since the creation of the British National Health Service in 1948, it has provided a full range of medical services free at the point of demand. By the mid 1980s, the National Health Service was perceived as suffering from a chronic crisis of an increasingly limited supply of medical resources but unlimited demand. The response of the Conservative government was to attempt to increase efficiency by introducing competitive dynamics with the creation of an internal market within the National Health Service. Health-care providers were to compete effectively with one another by price and quality. In this article, the author examines the prospects and problems inherent in such an internal market. The creation of fundholding general practitioners is scrutinized within the context of ideologic and financial goals of the British government and the potential consequences for patients.