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Funding the National Health Service: the Continuing Search for Alternatives

Published online by Cambridge University Press:  20 January 2009

Stephen J. Bailey  and
Allan Bruce
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Abstract

The article emphasises the urgent need for a reconsideration of potential sources of income for the National Health Service which could supplement rather than replace those from general taxation. They include local taxation, earmarked taxes, patient charges (hotel, prescription and other charges for non-clinical items), a lottery, income generation, charitable donations and patient ‘opting out’ of the NHS with private insurance. Analysis is set within the position statement provided by the 1989 White Paper Working for Patients and within a more general analytical framework paying attention to equity, accountability, value for money, management incentives and other criteria.

Each funding method is considered in terms of its consistency with the criteria of both the analytical framework and the White Paper. The differences between some of the alternative sources are found to be more apparent than real. Rather than providing a panacea for the perceived funding and rationing problems of the NHS, the danger is that new supplementary sources of finance may simply replace one set of problems with another. The new set may pose even more intractable problems and involve considerable short to medium term disruption of NHS finances. The inescapable fact is that decisions about the levels and quality of public service provision and their financing are ultimately matters of democratic accountability, decisions which cannot and should not be sidestepped by the convenience of income sources.

Type
Articles
Information
Journal of Social Policy , Volume 23 , Issue 4 , October 1994 , pp. 489 - 516
Copyright
Copyright © Cambridge University Press 1994

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References

REFERENCES

ACS (1993), Charging Older People for Care, Age Concern Scotland, Edinburgh.Google Scholar
Anon (1993), ‘Full charge’. The Economist, 29 05, p. 30.Google Scholar
Appleby, J. (1992), Financing Health Care in the 1990s, Milton Keynes, Open University Press.Google Scholar
Ashton, T. (1993), ‘Charging for health services – some anecdotes from the Antipodes’, in Malek, M., Rasquinha, J. and Vacini, P., Strategic Issues in Health Care Management, Wiley, Chichester.Google Scholar
Bailey, S. J. (1991). ‘Fiscal stress: the new system of local government finance in England’, Urban Studies, 28: 6, 889–907.CrossRefGoogle Scholar
Bailey, S. J. and Paddison, R. (1988), The Reform of Local Government Finance in Britain, Routledge, London.Google Scholar
Bailey, S. J., Falconer, P. K. and McChlery, S. (1993), Local Government Charges: Policy and Practice, Longmans, Harlow.Google Scholar
Bassett, M. (1994), A Health Cheque for All, European Policy Forum, London.Google Scholar
Black, D. (1980), Inequalities in Health: Report of a Research Working Group, Department of Health and Social Security, London.Google Scholar
Bracewell-Milnes, B. (1993), Customers Back in Charge: A Charter for Government Spending, Institute of Directors, London.Google Scholar
Bryson, L. (1992), Welfare and the State: Who Benefits?, Macmillan, London.Google Scholar
Butler, J. (1992a), Patients, Policies and Politics: Before and After ‘Working for Patients’, Open University Press, Milton Keynes.Google Scholar
Butler, P. (1992b), ‘Dangerous liaisons: joint capital ventures’, Health Service Journal, 12, p. 10.Google Scholar
CA (1993), Which? Way to Health, Consumers' Association, London.Google Scholar
Cm 555 (1989), Working for Patients, HMSO, London.Google Scholar
Cm 2219 (1993) Public Expenditure Analyses to 1995–96, HM Treasury, London.Google Scholar
Cmnd 6453 (1976), Local Government Finance: Report of the Committee of Enquiry (The Layfield Report), HMSO, London.Google Scholar
Cmnd 7615 (1979), Report of the Royal Commission on The National Health Service, HMSO, London.Google Scholar
Cmnd 9189 (1984), The Next Ten Years: Public Expenditure and Taxation into the 1990s, HMSO, London.Google Scholar
Cmnd 9663 (1956), Report of the Committee of Enquiry into The Cost of The National Health Service (chairman: C. W. Guillebaud), HMSO, London.Google Scholar
Cmnd 9756 (1986), The Reform of Personal Taxation, HMSO, London.Google Scholar
Cole, P., McGuire, A. and Stuart, P. (1985), More Money Better Health Care?: A Comparison of NHS Spending and Health Service Provision in Scotland and England, Discussion Paper no 03/85, Health Economics Research Unit, University of Aberdeen, Aberdeen.Google Scholar
Eckstien, H. (1958), The English Health Service, Harvard University Press, Cambridge MA.Google Scholar
Ensor, T. (1993), Future Health Care Options: Funding Health Care, IHSM Policy Unit, The Institute of Health Services Management, London.Google Scholar
Foster, P. (1983). Access to Welfare: An Introduction to Welfare Rationing, Macmillan, London.CrossRefGoogle Scholar
FSBR (1993), Financial Statement and Budget Report 1994–95, HM Treasury, London.Google Scholar
Game, C. (1984), ‘sAxeman or taxman – who is now the more unpopular?’ Local Government Studies, 10. 9–14.CrossRefGoogle Scholar
Green, D. and Lucas, D. (1993), Medicard: A Better Way to Pay for Medicines. Institute of Economic Affairs, London.Google Scholar
Harrison, S. (1988), Managing the National Health Service: Shifting the Frontier, Chapman and Hall, London.Google Scholar
Harrison, S., Hunter, D.J., Marnoch, G. and Pollitt, C. (1992), Just Managing: Power and Culture in the National Health Service, Macmillan. London.Google Scholar
Heald, D. (1990), ‘Charging by British government: evidence from the Public Expenditure Survey’, Financial Accountability and Management, 6: 4, 229–61.CrossRefGoogle Scholar
Henson, L. (1993), ‘How insurance recoupment could help the NHS’, Radiography Today, Journal of the College of Radiography, p. 37.Google Scholar
Hermans, H. E. G. M., Casparie, A. F. and Paelinck, J. H. P. (1992), Health Care in Europe After 1992, Dartmouth. Aldershot.Google Scholar
House of Commons Social Services Committee (1988), First Report 1987–88, Resourcing the National Health Service: Short Term Issues, HMSO, London.Google Scholar
Hunter, D. J. (1980), ‘Policy making in Area Health Boards: the role of the board member’, in Drucker, H. M. and Drucker, N. L. (eds.), The Scottish Government Yearbook 1981, Paul Harris, Edinburgh.Google Scholar
Hunter, D. J. (1983), ‘Centre-periphery relations in the National Health Service: facilitators or inhibitors of innovation?’, in Young, K. (ed.), National Interests and Local Government, Heinneman, London.Google Scholar
Hunter, D. (1993), ‘Something rotten in the state’, The Health Service Journal, 8 07, p. 21.Google Scholar
Hutton, B. (1993), ‘Health insurance that won't bleed you dry’. Financial Times, 9–10 10, Weekend FT, p. III.Google Scholar
Ignatief, H. (1991), ‘Citizenship and moral narcissism’, in G. Andrews (ed.). Citizenship, Lawrence Wishart, London.Google Scholar
IHSM (1993), Future Health Care Options. The Institute of Health Services Management, London.Google Scholar
Klein, R. (1988), ‘Financing health care: the three options’, British Medical Journal, 296. 734–6.CrossRefGoogle ScholarPubMed
Klein, R. (1989), The Politics of The National Health Service, 2nd edition, Longman, London.Google Scholar
Laing, W. (1993), Laing's Review of Private Health Care 1993, Laing and Buisson, London.Google Scholar
Le Grand, J. (1982). The Strategy of Equality: Redistribution and the Social Services, Allen & Unwin, London.Google Scholar
Le Grand, J., Winter, D. and Wooley, F. (1990), ‘The National Health Service: safe in whose hands?’, in Hills, J. (ed.), The State of Welfare: The Welfare State in Britain since 1974, Oxford University Press, Oxford.Google Scholar
Massie, A. (1988), How Should Health Services be Financed? Hume Paper no. 9, Aberdeen University Press, The David Hume Institute Aberdeen.Google Scholar
Millar, B. (1992a), ‘Begging the question’, Health Service Journal, 04, pp. 14–15.Google Scholar
Millar, B. (1992b). ‘Your money for your life’. Health Service Journal, 12, p. 16.Google Scholar
Millar, B. (1993), ‘Income generation’, Health Service Journal, 02, pp. 31–2.Google ScholarPubMed
Mulgan, G. and Murray, R. (1993), Reconnecting Taxation, DEMOS, London.Google Scholar
NAO (1993), Income Generation in the NHS Report by the Comptroller and Auditor General, HMSO, London.Google Scholar
OHE (1992), Compendium of Health Statistics (eighth edition). Office of Health Economics, London.Google Scholar
Paton, C. (1993), ‘Devolution and centralism in the National Health Service, Social Policy and Administration, 27: 2, 83–108.CrossRefGoogle Scholar
Randall, A. (1992). ‘USA: The health debate’, Health Services Management, 05, pp. 11–14.Google Scholar
Regan, D. E. and Stewart, J. D. (1982), ‘An essay in the government of health: a case for local authority control’. Social Policy and Administration, 16: 1, 19–43.CrossRefGoogle Scholar
Rose, R. (1984), Do Parties Make a Difference? Macmillan, London.CrossRefGoogle Scholar
Rose, R. (1990a), ‘Inheritance before choice in public policy’. Journal of Theoretical Politics, 2: 3, 263–91.Google Scholar
Rose, R. (1990b), ‘Charging for public services’, Public Administration, 68, 297–313.CrossRefGoogle Scholar
Rose, R. and Falconer, P. (1991), Institutional Constraints vs. Values: The Politics of Charging. Studies in Public Policy no 197, Centre for the Study of Public Policy, University of Strathclyde. Glasgow.Google Scholar
Taylor-Gooby, P. (1991), Social Change, Social Welfare and Social Science, Harvester Wheatsheaf, Hemel Hempstead.Google Scholar
Wagner, R. E. (1991), Charging for Government: User Charges and Earmarked Taxes in Principle and Practice, Routledge, London.Google Scholar
Wilson, D. (1987), ‘The welfare state in America’, in Ford, R. and Chakrabarti, M. (eds.), Welfare Abroad: An Introduction to Welfare Provision in Seven Countries, Scottish Academic Press, Edinburgh.Google Scholar