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The article talks about the British National Health Service (NHS), its five year forward view, and its goals of greater integration of care. Topics include similarities between integrated care systems in the U.S. and the proposed care models, namely multispecialty community providers and primary and acute are systems, the role of general practitioners, specialists, and accountable care organisations (ACOs) under the proposed models, and the challenges of implementing the NHS forward view.

Reports on the efforts of the state of Oregon to set priorities for health care on a systematic basis, as a result of the death of a seven-year-old boy who was waiting for a bone marrow transplant operation. Who the operation was led by; Approval of a legislation designed to provide access to health insurance for all residents in 1989; Provisions of the law; Concerns of critics regarding Medicaid. INSET: Summary points.

The authors discuss the lessons for the Great Britain National Health Service (NHS), as the plans of the U.S. government to establish clinical commissioning groups are taken forward. The authors say that the private insurers in the U.S. are competing to attract members who may be individual subscribers. They add that the increase in health-care costs which is contributed by the use of activity-based funding for hospitals has led some insurers to explore alternative payment approach.

Examines the differences between the NHS and the American health systems and remarks that the UK shows greater interest in learning from the US than visa versa. Comparison of the two systems and their costs; Ratings of the systems by the World Health Organisation which placed the UK in 18th and the US in 37th place out of the 191 countries studied; Example of the NHS using US policy which is seen in the policy on chronic disease; Reasons why the British system is hard to export to the US; Belief that learning partnerships between the two countries is wiser than just copying each other; Advantages of trading information to both systems.

A letter to the editor is presented in response to the article "The NHS five year forward view: lessons from the United States in developing new care models" in the April 21, 2015 issue.

The author discusses problems prevailing in National Health Service (NHS) on delivering quality care to patients. He states that the liberty of doctors explain why there are variations in medical practice. He mentions that it is important to appoint doctors to keep a careful watch on scarce public resources. The author also discusses U.S. healthcare organizations which are led by doctors and provide high quality care.

The health reforms in England have entered a phase in which greater emphasis is being placed on market-like mechanisms. The ability of the commissioners of care to negotiate on equal terms with providers will be of critical importance in the emerging market. The government has set out plans to develop 'world class commissioning' and this essay reviews experience in Europe, New Zealand and the United States to understand what is involved in working towards this goal. The evidence reviewed shows that in no system is commissioning done consistently well and highlights the obstacles to the development of world class commissioning. The reasons for this centre on the complexity of health care and the inherent difficulty of commissioning health services in publicly financed systems. Commissioners will need to be able to access a range of expertise and are likely to incur significant expenditure in so doing. There are warning signs from other systems of health reforms that result in adversarial and legalistic approaches, and do not give sufficient attention to relational contracting. Even if world class commissioning is developed, it may fall short of its potential in the absence of other changes in the design of the reforms, such as autonomous providers and appropriate payment systems. In view of these challenges, a more promising alternative would be to develop competing integrated systems.