Why Britain is reorganizing its national health service--yet again

The Labour government's 1997 plans for Britain's National Health Service (NHS) have been presented as a reaction to the reforms introduced by its Conservative predecessor in 1991. But to a large extent they build on the Conservative legacy. The centerpiece of the Labour reform--managed care organizations based on groups of primary care physicians--is based on the Conservative experiment with general practitioner fund holding. Welcomed when published, Labour's plans may arouse opposition in implementation, for they imply greater central control and threaten medical autonomy. If the political costs are to be contained, Labour may have to choose between increasing spending on the NHS or making concessions to the medical profession--and quite possibly have to do both.