The Economics of Bureaucracy and the British National Health Service

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mists have analyzed the British National Health Service (NHS). Common to most of these studies are the findings that the NHS has failed to achieve efficiency in the use of resources and equality in access to health care. However, the studies differ with respect to what is the basic cause of these problems. Cooper (1975) and Culyer (1976) seem to argue that the problem is essentially one of poor information and excessive discretion on the part of physicians. According to Cooper (1975:107), "the clinical freedom to differ widely as to their [physicians'] conception of need has led to inconsistencies of treatment between patients and to the allocation, without challenge, of scarce resources to medical practices of no proven value." He also notes that "lack of research into indicators of need has enabled gross inequalities of provision to persist on the grounds that, in the absence of any evidence to the contrary, they might in fact, however accidentally, reflect needs" (Cooper, 1975:109). In a similar vein, Culyer (1976:110) claims that "the efficient and fair operation of the health service requires the establishment of national norms and a substantial reduction in the discretion of individual hospital doctors." The latter would be accomplished by requiring