ABSTRACT
This chapter looks at the theoretical background to the development of quasi-markets in health care and considers the implications of this development for the system. It focuses on the importance of theories of power for any understanding of health policy and highlights the relevance of Habermas’ communicative ethics to an analysis of decision making in the National Health Service (NHS). The NHS was originally set up on the basis that it would provide universal health care to all, free at the point of need. T. McKeown has argued that most of the improvements in life expectancy and in health status from the 17th century onwards can be attributed, in the main, to improvements in socio-economic conditions and not to the developments made in modern health care. The chapter argues that the ability of interest groups to override needs based arguments and even to use needs based arguments to promote particular interests, remained a dominant characteristic of the system.
