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In the past two decades, as with other European countries, the United Kingdom has experienced a number of profound changes in financing and institutional arrangements in its health systems, characterised by increased emphasis on mixed financing, with greater use of private funding, reduced reliance on hierarchies for decision-making in favour of flatter management arrangements, progressive expansion of markets and market-like mechanisms for resource allocation, and novel public-private relationships—loosely referred to as public-private partnerships. In practice, the scope and extent of these “partnerships” greatly vary in relation to financing and delivery of healthcare services. There is increased use of private funding for capital projects in the NHS, along with a growth of supplementary voluntary insurance and out-of-pocket payments by citizens. In service delivery, approaches to public-private partnerships have ranged from (i) privatisation of healthcare services previously managed by local or central government (involving the sale or transfer of assets—for example, primary care, pharmacies and dentists), (ii) outsourcing of publicly funded services from the private sector (for example, diagnostic services, elective surgery and management support contracted out to private sector providers), (iii) creation of hybrid organisations (such as private financing and management of capital development projects and estates management while retaining public-sector service delivery), and (iv) transforming or “modernising” work practices in public organisations with the introduction of private-sector management practices (such as performance-related pay and business process re-engineering). Collectively, these structural changes in European health systems and the UK have introduced “quasi-markets” and competition, emphasised “value for money” and encouraged expansion of private-sector involvement in financing and delivery of healthcare services with the aim of boosting health system efficiency and enhancing citizens’ choice of healthcare providers.1
The desire to “reinvent the government”2 by downsizing the state to a set …
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