ABSTRACT
The process of health system ‘reform’ is virtually universal in developed, and increasingly in developing, societies and by and large the forces advanced as promoting the ‘reform’ process are described in similar terms. In the United Kingdom, the previous Conservative government was driven in its attitude to public services by three fundamental and pervasive values or principles, which have particular importance for the subsequent interest in priority setting. A very strong directional force to the subsequent priority-setting debate can be detected here with the explicit goal of obtaining greater value from a constrained budget. Ever since the inception of the National Health Service (NHS), access to healthcare has been restricted in one form or another. Planners and politicians could influence priorities by determining which facilities/services to provide and their location, thus restricting access both by capacity and by distance. The problems and opportunities afforded by the purchaser-provider split are likely to continue.
