A 'fair innings' for efficiency in health services?

This paper reviews the severe visual focus problems of health economists-th ey have developed a one-sided fixation with equity issues, neglecting the e fficiency agenda. The problems of meeting need are not just about access-th ey will vary with cost and supply. Economists in fact developed a more bala nced agenda in the 1970s but have failed to follow it up. The paper defines the triple nationalisation of the National Health Service (NHS), and prese nts evidence that pluralism, using the purchaser/provider split, has become more efficient in long terra care, home care and services for people with learning difficulties. Health economics has failed to explore options for u sing the dynamic forces of choice and competition for improving health serv ices. The paper makes the case for a decision rule that "we should seek the process of health care service supply and development which maximises the delivery of high quality, lower cost user relevant services".