CLINICAL AND ECONOMIC CONSEQUENCES OF PATIENTS AS PRODUCERS

NHS market 'reforms' and the world-wide drift toward managed competiti on in health services rest on a fundamental misunderstanding of the na ture of health production through medical and nursing care. Optimally efficient health production depends on a general shift of patients fro m their traditional role as passive or adversarial consumers, to becom e producers of health jointly with their health professionals, in an e ssentially co-operative rather than competitive public service.