What are ‘third way’ governments learning? Health care consumers and quality in England and Germany

Market-oriented, demand-driven health care reforms and equity in health and health care utilization in Sweden

In international comparisons, the Swedish health care system has been seen to perform well. In recent years, market-oriented, demand-driven health care reforms aimed at free choice of provider by patients and free establishment of doctors are increasingly promoted in Sweden. The stated objective is to improve access and efficiency in health services and to provide more and/or better services for the money. Swedish health policy aims to provide equal access to care, based on equal need. However, the social and economic gradient in disease and ill health does not translate into the same social and economic gradient in demand for health services. A market-oriented, demand-driven health care system runs the risk of defeating the health policy aims and of further increasing gaps between social groups in access and utilization of health care services, to the detriment of those with greater needs, unless it is coupled with need-based allocation of resources and empowerment of these groups.

New localism in the English National Health Service: What is it for?

This paper discusses the decentralisation in the English National Health Service (and the new organisational form of Foundation Trusts, in particular) in the context of the trend for decentralising public services generally since the New Labour government started its second term of office in 2001. It considers the likelihood of decentralisation achieving the aims policy makers have set: these are better services and an increase in local people's participation in the planning and running of services (active citizenship). Looking at the evidence to date, both about decentralisation of health services and about Foundation Trusts, the achievement of these goals seems uncertain.