About | HeinOnline Law Journal Library | HeinOnline Law Journal Library | HeinOnline
LOG IN
LOG IN

14 Health Econ. Pol'y & L. 1 (2019)

handle is hein.journals/hecpol14 and id is 1 raw text is: Health Economics, Policy and Law (2019), 14, 1-10 0 Cambridge University Press 2018 doi:10.1017/S1744133117000354 The National Health Service (NHS) at 70: Bevan's double-edged legacy RUDOLF KLEIN* Honorary Professor, London School of Hygiene and Tropical Medicine, London, UK Abstract: The paper analyses the achievements and problems stemming from Nye Bevan's model of a tax funded national health care system, on the assumption that only so could equity be achieved. The evidence shows that indeed the National Health Service (NHS) scores highly on equity, so vindicating Bevan's vision. The price paid is that fiscal crises are the norm for the NHS, with ever more centralisation, intensive regulation and performance management. Successive reorganisations represent attempts to square the circle - to combine the strengths of Bevan's model and those of a less hierarchic system - but have so far failed to deliver and can be expected to continue. Submitted 31 October 2017; revised 7 November 2017; accepted 8 November 2017; first published online 8 January 2018 Perhaps the most remarkable aspect of the National Health Service (NHS), as it celebrates its 70th birthday, is its survival in an institutional form that would still be recognised by its original architect, Nye Bevan. Cushioned in overwhelming public support, with the medical profession long since transformed from being its most hostile critics into its most committed defenders, it has survived successive waves of reorganisation and periods of fiscal austerity. Regular prophecies of the NHS's impending implosion (Powell, 2015) have been regularly defied. The Lansley reorganisation - which prompted such an outcry - is now a historical curiosity. The NHS has not been privatised. And competition is giving way to integration. Just as the 1989 introduction of market notions was the policy response to fiscal stress, so now fiscal stress is prompting a retreat from those notions. All this would seem to be a tribute to Bevan's design. But success in terms of both survival and achievement has come at a price. Shaping Bevan's design was his ambition to achieve equity, defined as equal access to health care for all. This has been largely achieved (see below) and support for the principle helps to explain why the NHS commands public loyalty even in hard times. But the logic of *Correspondence to: Professor Rudolf Klein, 12A Laurier Road, London NW5 1SG, UK. Email: rudolfklein30@gmail.com

What Is HeinOnline?

HeinOnline is a subscription-based resource containing thousands of academic and legal journals from inception; complete coverage of government documents such as U.S. Statutes at Large, U.S. Code, Federal Register, Code of Federal Regulations, U.S. Reports, and much more. Documents are image-based, fully searchable PDFs with the authority of print combined with the accessibility of a user-friendly and powerful database. For more information, request a quote or trial for your organization below.



Short-term subscription options include 24 hours, 48 hours, or 1 week to HeinOnline.

Purchase Access

Contact us for annual subscription options:

Contact Us

Already a HeinOnline Subscriber?

Log In

profiles profiles most