Health policy
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Our objective in this paper is to assess the value of early discharge schemes following the economic evaluation of three such schemes in New South Wales, Australia. An early discharge programme for obstetric patients, a fractured hip management programme and a continuing community cancer care programme were evaluated. The results of the economic evaluation of these schemes are discussed in the light of four commonly held beliefs about the value of early discharge: that early discharge schemes succeed in reducing length of stay, that early discharge schemes save money, that the welfare of patients is not reduced by early discharge and that early discharge schemes are cost-effective. The caution expressed by previous authors about the perceived advantages of early discharge schemes is still warranted.
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In this paper, the new NHS is put in a global context, comparing the UK internal market arrangements with changes occurring in other health care systems. An assessment is made of whether the new UK NHS will result in more efficient and equitable health care provision than the 'old' NHS. Regarding financing of health care, most countries seem to be moving in the direction of NHS or public-insurance-based systems. ⋯ In terms of allocative efficiency and equity, we believe that, on balance, the new NHS will bring no improvement. Indeed, in terms of equity, it may be detrimental. If there is any improvement, it is likely to be in technical efficiency.
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Concern about the size of the NHS drugs bill in the UK has resulted in three main policy initiatives by government: regular increases in prescription charges, the introduction of restrictions on the range of prescribable drugs, and the implementation of prescribing budgets. This paper argues that such policies, whilst reducing the NHS drugs bill, have given little consideration to the efficiency of prescribing. Other policy options are considered which may reduce the NHS drugs bill in ways more consistent with efficient prescribing.