Samuel Mencher spent a year in Great Britain (1965-1966) interviewing leaders of professional medical associations, executives of the health insurance societies, and general practitioners and specialists engaged in private practice. His study of the private medical service twenty years after the passage of the National Health Service Act reviews the changes, problems, and successes of the National Health Service: trends in the amount and types of private medicine, the issues of conflict between private medicine and public policy, and attitudes of the public and of medical professionals.
This review incorporates the views and visions of 2,000 clinicians and other health and social care professionals from every NHS region in England, and has been developed in discussion with patients, carers and the general public. The changes proposed are locally-led, patient-centred and clinically driven. Chapter 2 identifies the challenges facing the NHS in the 21st century: ever higher expectations; demand driven by demographics as people live longer; health in an age of information and connectivity; the changing nature of disease; advances in treatment; a changing health workplace. Chapter 3 outlines the proposals to deliver high quality care for patients and the public, with an emphasis on helping people to stay healthy, empowering patients, providing the most effective treatments, and keeping patients as safe as possible in healthcare environments. The importance of quality in all aspects of the NHS is reinforced in chapter 4, and must be understood from the perspective of the patient's safety, experience in care received and the effectiveness of that care. Best practice will be widely promoted, with a central role for the National Institute for Health and Clinical Excellence (NICE) in expanding national standards. This will bring clarity to the high standards expected and quality performance will be measured and published. The review outlines the need to put frontline staff in control of this drive for quality (chapter 5), with greater freedom to use their expertise and skill and decision-making to find innovative ways to improve care for patients. Clinical and managerial leadership skills at the local level need further development, and all levels of staff will receive support through education and training (chapter 6). The review recommends the introduction of an NHS Constitution (chapter 7). The final chapter sets out the means of implementation.
No two markets for voluntary health insurance (VHI) are identical. All differ in some way because they are heavily shaped by the nature and performance of publicly financed health systems and by the contexts in which they have evolved. This volume contains short structured profiles of markets for VHI in 34 countries in Europe. These are drawn from European Union member states plus Armenia Iceland Georgia Norway the Russian Federation Switzerland and Ukraine. The book is aimed at policy-makers and researchers interested in knowing more about how VHI works in practice in a wide range of contexts. Each profile written by one or more local experts identifies gaps in publicly-financed health coverage describes the role VHI plays outlines the way in which the market for VHI operates summarises public policy towards VHI including major developments over time and highlights national debates and challenges. The book is part of a study on VHI in Europe prepared jointly by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. A companion volume provides an analytical overview of VHI markets across the 34 countries.
An analysis of the transition from universal, publicly funded health care to New Labour's application of market principles, 'NHS plc' portrays a national institution reaching crisis point and serves as a key lesson for those concerned with health care.
Before World War II, the great majority of practicing doctors in England and Wales were general practitioners. They performed their own surgery, and were accustomed to treating a wide variety of illnesses and symptoms. Specialists were few in number, tended to practice in large towns, and were often associated with major hospitals. But rapidly changing medical institutions and services in the twentieth century have compelled specialization even among more modest doctors and hospitals. While medical specialization was not new-for centuries physicians were differentiated from surgeons-twentieth-century science and technology emphasized and accelerated this difference rapidly. Medical care began to shift from services rendered by the general practitioner to the employment of those doctors with a special interest-for example, pathology, neurology, or cardiology. Author Rosemary Stevens, an expert in public health, traces, especially within the last two centuries, the patterns of English medical practice, institutions, staffing, and training, and their influence on specialization, the British National Health Service Act, and post-World War II developments. Stevens discusses the ever-relevant issues of income determination, medical education, and the future of the general practitioner in an age of specialization. Along with its companion volume, Medical Practice in Modern England is a book that will be of lasting value to scholars of medicine, medical care organization, economics, and modern social history. It is of special importance at a time of crisis in the health care systems of many European Societies. "A fine book. Carefully constructed, factual, elaborately researched, gracefully written."-George A. Silver, M.D., professor emeritus of epidemiology and public health, Yale University. Rosemary Stevens is professor emeritus of history and sociology of science at the University of Pennsyvlania. Educated at Oxford, Yale, and Manchester, she has also taught at Yale University and Tulane University. She is the author of American Medicine and the Public Interest and In Sickness and in Wealth: American Hospitals in the Twentieth Century.
What are public health services? Countries across Europe understand what they are or what they should include differently. This study describes the experiences of nine countries detailing the ways they have opted to organize and finance public health services and train and employ their public health workforce. It covers England France Germany Italy the Netherlands Slovenia Sweden Poland and the Republic of Moldova and aims to give insights into current practice that will support decision-makers in their efforts to strengthen public health capacities and services. Each country chapter captures the historical background of public health services and the context in which they operate; sets out the main organizational structures; assesses the sources of public health financing and how it is allocated; explains the training and employment of the public health workforce; and analyses existing frameworks for quality and performance assessment. The study reveals a wide range of experience and variation across Europe and clearly illustrates two fundamentally different approaches to public health services: integration with curative health services (as in Slovenia or Sweden) or organization and provision through a separate parallel structure (Republic of Moldova). The case studies explore the context that explain this divergence and its implications. This study is the result of close collaboration between the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe Division of Health Systems and Public Health. It accompanies two other Observatory publications Organization and financing of public health services in Europe and The role of public health organizations in addressing public health problems in Europe: the case of obesity alcohol and antimicrobial resistance (both forthcoming).
The Government recognises that many lifestyle-driven health problems are at alarming levels: obesity; high rates of sexually transmitted infections; a relatively large population of drug users; rising levels of harm from alcohol; 80,000 deaths a year from smoking; poor mental health; health inequalities between rich and poor. This white paper outlines the Government's proposals to protect the population from serious health threats; help people live longer, healthier and more fulfilling lives; and improve the health of the poorest. It aims to empower individuals to make healthy choices and give communities and local government the freedom, responsibility and funding to innovate and develop ways of improving public health in their area. The paper responds to Sir Michael Marmot's strategic review of health inequalities in England post 2010 - "Fair society, healthy lives" (available at http://www.marmotreview.org/AssetLibrary/pdfs/Reports/FairSocietyHealthyLives.pdf) and adopts its life course framework for tackling the wider social determinants of health. A new dedicated public health service - Public Health England - will be created to ensure excellence, expertise and responsiveness, particularly on health protection where a national response is vital. The paper gives a timetable showing how the proposals will be implemented and an annex sets out a vision of the role of the Director of Public Health. The Department is also publishing a fuller story on the health of England in "Our health and wellbeing today" (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122238.pdf), detailing the challenges and opportunities, and in 2011 will issue documents on major public health issues.
This study provides a descriptive overview of the market for supplementary voluntary health insurance (VHI), or private medical insurance (PMI), in the United Kingdom. The structure of the study reflects the three principal dimensions of the market: the product, demand, and supply. An appendix discusses the market for health cash plans.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
