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The New Zealand health system was substantially reformed in 1993 with the introduction of a purchaser-provider split, competitive contracting and managerialism. The new system failed to deliver the desired gains and, in 1996, the reforms were "reformed". While there has been widespread study of the 1993 reforms, there has been little discussion to date of the 1996 changes and the emerging directions for New Zealand health policy and service delivery, which remain unclear. This paper discusses the New Zealand health reforms of the 1990s. It briefly outlines the 1993 reforms and their results. Next, it details the 1996 "reforms". Third, it discusses developments since 1996, some of which have emerged out of the 1993 reforms, but which have gathered momentum only since the 1996 changes were announced. In the conclusion, the paper lists some of the directions in which the New Zealand health sector appears to be heading, noting that there is a need for coordination of the sector, and for permanence. [ABSTRACT FROM AUTHOR]

Cancer is a major cause of death and ill health, accounting for roughly one in four deaths in the UK. Concern with cancer services was expressed in the 1990s when it was reported that the quality of cancer care was patchy and variable, and clinical outcomes varied in different parts of the country. The Calman-Hine Report (1995) produced specific recommendations for the reorganizing and reconfiguring of cancer services, but although the Conservative government, which commissioned the report, endorsed its suggestions no additional funding was provided to implement the proposed changes, and consequently there remained variations in provision across geographical areas and between patients with different cancer types. However, since 1997 the Labour government has targeted cancer, appointing a Cancer Tsar, announcing a package of measures to“fight the war against cancer”, including the publication of a) and with Tony Blair pledging to end the postcode lottery for cancer treatment. This paper explores the concept of the“postcode lottery of cancer care”, why it exists and whether measures taken since the Calman-Hine Report and the Cancer Plan will address it. [ABSTRACT FROM AUTHOR]

In England, the quality of clinical work is being regulated in new ways following recent developments in “clinical governance” policy and apparent failures in the previous system of medical self-regulation. Using multiple case studies, this paper examines how these changes are affecting professional governmentality and discipline in general practice. Formal organizational structures play little role in clinical governance there. Clinical quality is managed largely through semi-formal networks, relying on medical self-surveillance. Compliance is achieved largely by discursive appeals to the legitimacy of clinical governance, but local GPs’ leaders also argue that governments might otherwise regulate medical practice more actively. As yet the effects of clinical governance activity on service delivery are slight. Professional self-regulation is replacing permissive exception management with more collegial, directive methods. [ABSTRACT FROM AUTHOR]

Government policy in the UK has been to provide comprehensive personalized health care to the whole population free at the point of delivery. However, the first major attempt to unify and regionalize the service in 1974 left a number of problems, and a further restructuring of the, NHS was required. This article reports on the results of research into the 1982 restructuring. The main feature of this second reorganization was the formation of territorial entities called "Districts "', and their organizational subdivision into "Units ". The kind and level of work and authority assigned to Districts and Units is discussed. An important finding, seemingly counter to official policy, is the existence of small Districts which operate at the same level as Units of the larger Districts. [ABSTRACT FROM AUTHOR]

National decisions on the drugs, treatments and medical devices that should be funded through public expenditure are a fundamental element of health policy. But despite a political emphasis upon evidence-based policy, the results of rigorous clinical trials and statistical modelling techniques rarely speak for themselves. So, does the pre-eminence traditionally accorded to quantitative data in the medical field underpin policy decisions on a consistent basis? Or are more subtle, less transparent characteristics of context and interaction evident in the shaping of attendant decisions? This article considers these questions by drawing on a study of decision-making in the National Institute for Health and Clinical Excellence (NICE)—an organization established by the British government in 1999 to decide whether selected health technologies should be made available throughout the National Health Service in England and Wales. In broad terms, the findings point to the primacy of arguments based on quantitatively oriented, experimentally derived data but also to a discursive hegemony of clinicians and health economists in mediating, including or debarring more qualitative, experientially based evidence. A more complex, dynamic understanding of policy governance in the field of health technology appraisal—founded on a discursive appropriation of the idea of the “common good”—goes some way to explaining the persistence of this hegemony despite an avowedly inclusive, plural approach to decision-making. [ABSTRACT FROM AUTHOR]

Current government policy places great importance both on clinical governance and on partnership working between health and social services. Separately and together, these policy emphases require greater clarity in and between organizations about who should provide what care where than has often been achieved in the past. A study of the implementation of continuing health care policies suggests that clarity about appropriate long–term health and social care provision was difficult to achieve in the 1990s quasi–markets, because there were too few financial and structural incentives for agencies to cooperate in developing and implementing precise and comprehensive eligibility criteria. This problematic interplay between financial and structural factors is being addressed by a number of government initiatives designed to stimulate joint working, although the difficulty of drawing a clear boundary between health care (free at the point of delivery) and social care (which can be means–tested) remains. [ABSTRACT FROM AUTHOR]

The article discusses the use of Performance Indicators to improve the management of the National Health Services (NHS) in Great Britain. The British government believes that the NHS can provide a better service using the services available to it. According to the author, health authorities should not assume that more money will always be available to be spent on health care and that they should aim to make the best use of what they have. Britain's Secretary of State Norman Fowler stated that the use of Performance Indicators would enable the District Health Authorities to use manpower and other resources more efficiently in the delivery of health services.