ABSTRACT
The reforms to the National Health Service (NHS), introduced by the government of the United Kingdom (UK) in April 1991, were widely judged as inaugurating the most radical changes to the service since its inception in 1948. Even so, they were still representative of an international trend during the last decade or more when health care reform was commonplace (Wagstaff et al., 1993). For whilst the Thatcher regime was perhaps one of the most noted advocates of market mechanisms in welfare provision, their reforms to the NHS reflected a pattern of change that can be seen to various degrees almost everywhere in Europe (Baldock, 1993; Brommels, 1995; Saltman and von Otter, 1995). Indeed, there is room for states to learn from each other’s experiences (Ham, 1996a; 1997a), even though the precise pattern of the changes in different countries have been specific to each individual nation (Kane, 1995).
