EVALUATING HEALTH-CARE REFORM - THE CASE OF THE NHS INTERNAL MARKET

The NHS internal market, introduced in an atmosphere of controversy, c ontinues to generate much disagreement. This article examines the evid ence on the impact of this policy with regard to a range of criteria, including efficiency, accountability, effective planning and co-ordina tion, patient choice and service quality, equity, and the culture of t he NHS. It explores the different ways in which this evidence is perce ived and seeks to make explicit the assumptions and biases of those in volved in the debate about the reforms. The article also examines the policy process behind the reforms and the extent to which it has added to the problems of evaluation. By way of conclusion, the implications for future health care reform are considered and a number of procedur al changes suggested.