Health affairs
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In 2002 Canadians were less anxious about the state of their health care system than they were a few years earlier, when perceptions peaked that the system needed major reform. They expressed strong support in 2002 for maintaining the status quo on health care financing (that is, no user fees and no two-tier care) within the traditional domains of physician and hospital care. But they appeared more receptive to two-tier care and for-profit delivery for the newer and rapidly expanding domains of home care and high-tech care.
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With large funding increases planned for the next five years, England's National Health Service (NHS) has embarked on an ambitious program of system reform. This paper considers the main reform strategies now being deployed and assesses three potentially competing assumptions underpinning them. ⋯ The second advocates more hierarchical control to offset self-interested provider behavior, and the third stresses the role of local incentives and accountability. How these reforms play out over the next five years will determine the future shape of English health care.