Following on that, has anything that looks like heavily regulated market competition among integrated care organizations ever been established anywhere?
Cheerfully,
Michael
Sent from my iPad
On May 22, 2012, at 12:38 PM, "Calum Paton" <[log in to unmask]> wrote:
> Chris,
>
> No offence - was having fun being Mr. Grumpy.
>
> Re the serious debate: I do feel strongly that the health reform
> industry in England has (what's the quote from Harold Wilson) taken
> minutes* and wasted years.
>
> (*in this case, produced myriads of policy changes in
> cyclical and indeed circular direction of travel)
>
> I know you can have 'integrated care' in a market context, or shall we say
> in a 'post-purchaser/provider split' politics. Competing HMOs/Enthoven's
> original model of managed competition (for Bismarck rather than Beveridge
> contexts): in England, citizens could choose among 'HMOs' ie
> commissioner/provider organisations with no geographical catchment basis as
> PCTs/CCGs had/have.....OR.....HAs/ PCTs/CCGs could be the
> purchaser/commissioner choosing among 'integrated care organizations' ie the
> citizen is still with the geographical purchaser, which chooses among
> different 'integrated' providers.
>
> But to me these are Heath Robinson-esque, tortuous means of ticking the
> 'market' box. This is done either on the grounds of ideology or out of
> pragmatism (ie Old Tory/ New Labour/Coalition neo-liberalism is the only
> show in town) ....OR on the grounds that integrated care without competition
> is bound to lead to what Simon Stevens calls doctors colluding behind the
> bike-sheds.
>
> But the 'empirical' question then becomes: is 21 years of market economics
> moderated by 'garbage-can' (Cohen, March and Olsen) politics more
> efficient/effective than a planned, integrated health service with
> appropriate targets and outcome criteria? Put it another way: if all the
> investment' in commissioning/the market/whatever had been applied instead to
> improving and integrating a non-market NHS, would we have got just as much
> benefit or more?
>
> Best, Calum
|