THE QUASI-MARKET, THE ENTREPRENEUR AND THE EFFECTIVENESS OF THE NHS BUSINESS MANAGER

The recent changes in the UK National Health Service were heralded by the publication of the Griffiths report in 1983 which highlighted the need for a 'business-like' approach to management. The policy makers' generic strategy of the late 1980s and early 1990s centred around the concept of 'quasi-markets'. These were artificial internal markets enc ompassing the purchasers and providers of public services. Little rese arch has been undertaken into this new phenomenon of the 'quasi-market ' but entrepreneurship economic theory would suggest that for markets to be efficient would require a supply of alert and aware entrepreneur s. Within the restructured NHS, the mantle for entrepreneurial managem ent seems to have been placed firmly on the shoulders of the newly cre ated 'business managers'. A 1993 survey amongst NHS business managers in first and second wave trust hospitals in the Trent Regional Health Authority indicated that whilst business managers were knowledgable of what entrepreneurial activity is, they currently feel constrained in their new roles for a variety of reasons. The authors suggest that rat ional economic analysis is insufficient to explain this lack of innova tory endeavour. Instead policy makers' attention should be devoted to liberating health managers from their current constraints to encourage their entrepreneurial development.