ABSTRACT
The internal market is the single most unpopular thing in British health care. The internal or 'quasi' market was introduced into the National Health Service (NHS) to produce a politically acceptable solution to an increasingly unattractive economic reality. The internal market was seen as the best way of dealing with the specific problems presented by the British health system. Many of the problems of the internal market come through attempts to limit the logic of the real market. The market was introduced to bring in efficiency, but the market itself had to be managed. At the top level, the problems posed by political interference in the new system dated back to the mid 1980s, when Victor Paige resigned as chairman of the new, supposedly powerful NHS management board. Later, he wrote that ministers took all the important decisions because the NHS was surrounded by such high political pressure.
