Health care technology in the United Kingdom

Home care and the reshaping of acute hospitals in England. An overview of problems and possibilities

A changing boundary between hospital and home-care services over two decades has taken place enabling people to live in their own homes wherever possible, enabling "choice of independence". Against this background, five principal issues are raised regarding how hospital services have been reshaped over that time and how the pattern of service developments outside the hospital has altered over the same period.

Decentralisation from acute to home care settings in England

The impact of technology and resource constraints on acute care, the concept of a 'primary-care led National Health Service' (NHS), and the emphasis on developing community-based alternatives to institutional care have contributed to a reshaping of the respective roles of acute and home care services over the past 10-15 years in the United Kingdom. In England, recent reforms are allowing GP Fundholders, District Health Authorities representing a specific geographic area, and local government social services departments to purchase both acute and community-based care. In addition, new constraints on further expansion of institutional long-term care are encouraging the substitution of home care for the elderly needing long term care services. The result has been a dramatic increase in use of home care services. However, resource and supply constraints impede further home care expansion. Other forces within the NHS continue to foster unnecessary post-acute institutionalization. The successful decentralization of acute services from hospitals to home care requires an integrated program across the continuum of health and social services. In practice, no such concerted program exists.

EUR-ASSESS Project Subgroup Report on Coverage

The issue of health benefits coverage—and its relation to health technology assessment (HTA)—has gained increasing attention in recent years. Economic constraints on health care, as well as the rapid pace of technological change, have forced European countries to face difficult choices in providing such care. The active use of coverage decision making has been proposed as a tool to help rationalize health care, and HTA has been advocated as a necessary activity to improve coverage decisions.