The paper's focus is on the notably pragmatic style and processes of reform in the UK. Selected key themes illustrate aspects of this. They comprise: the separation of purchaser-provider responsibilities and the development of an internal market in health care. Many of the changes now being introduced were not part of the original proposals put forward in 1989. They emerged in response to Ministers' wishes or preferences as they became caught up in implementation and were held accountable for its achievement. In assessing the NHS reforms, a major problem has been the lack of sound, independent research to evaluate their impact. The limited, though growing, research that has been conducted suffers from being unable to distinguish causality from association. Few reliable conclusions about the impact of the reforms can be drawn from research. It remains virtually impossible at this time to draw up a definitive, overall balance sheet. A number of political lessons are identified. If the preconditions prevailing in the UK in late 1988 and early 1989 were to exist elsewhere then reforms similar to those in the UK may be forthcoming. It is important, however, not to overlook the particular factors evident in any country which will ultimately determine the nature of health care reforms and their outcome.

Volume 22

Numbers 3-4