The Quasi Market in Health Care: Pre-requisites, Problems and Prospects

Abstract

This paper evaluates the operation of the quasi market in health care after the implementation of the reforms set out in the White Paper ‘Working for Patients’ (DoH, 1989a), which replaced the largely state run monopoly provision of health and social services by a state financed internal market. Lying behind the reforms was the assumption that the move away from bureaucratic, to market oriented, systems in the allocation of health and social care would lead to improvements in service efficiency, and responsiveness. This was to be achieved by separating state authorities' purchasing and providing roles, and the introduction of contracts. Using the framework developed by Le Grand and Bartlett (1993), this paper assesses the extent to which the internal market for acute services in Northern Ireland is meeting the expected outcome criteria of efficiency, responsiveness, choice, quality and equity. A survey of purchasers and providers of acute hospital services was conducted, followed by in-depth interviews with the stakeholders in the contracting process. Analysis of the quantitative data, and preliminary consideration of the qualitative data, would indicate that the potential benefits are yet to be fully realised.