ABSTRACT
Tax funded universal health systems are characterised by administrative functions that focus on needs assessment and resource allocation across geographic populations so as to ensure comprehensive coverage that is country and system-wide. This is because in universal systems, financial risk is pooled at government level. In market systems, however, financial risks are allocated (spread) across different parts of the system through market contracting. Administrative functions in these systems focus on risk pricing and segmentation among providers, members or enrollees. Using the example of the English National Health Service (NHS), we argue that the information systems required to enable risk segmentation are different from those underpinning comprehensive care. Administration is non-geographic in market bureaucracies and geographic in comprehensive systems. This leads to a shift in information requirements that poses difficulties for resource allocation and service planning, and therefore for universalist goals.
