The UK’s natural experiment in governing health care
Four countries, one NHS — how do different policies lead to different outcomes?
Devolution in 1999 turned the United Kingdom into a natural experiment. Four countries kept a tax-funded NHS, free at the point of use, and then ran it four different ways: England with targets, published ratings and provider competition, the others mostly without. With Nicholas Mays, Sheelah Connolly and colleagues at the Nuffield Trust, Gwyn compared the funding and performance of the four systems before and after devolution. His own reading is that the difference is one of governance models: “knights” trusted to do the right thing against “knaves” given incentives, with England’s provider challenge set against provider capture elsewhere.
- The United Kingdom (Chapter 6)
- The four health systems of the United Kingdom: how do they compare?The four UK health services compared, before devolution and after.
- The impacts of asymmetric devolution on health care in the four countries of the UK
- Funding and performance of healthcare systems in the four countries of the UK before and after devolution
- Impact of devolution of health care in the UK: provider challenge in England and provider capture in Wales, Scotland and Northern Ireland?
- Performance measurement of 'knights' and 'knaves': differences in approaches and impacts in British countries after devolution
- Effect of diverging policy across the NHS