Competition, Cooperation, Or Control? Tales From The British National Health Service In the battle between market competition and central control in Britain’s health care system, control won. Will Labour’s new version of the market prevail? by Julian Le Grand PROLOGUE: In July 1998 the British National Health Service (NHS) marked its fiftieth anniversary. The NHS brought together in one organization, for the first time, hospital, physician, and community health services—and also posed administrative and fiscal challenges that continue to plague it. Britain undertook the latest in a series of reforms after the New Labour party assumed power in 1997. This latest reform, which represents a “third way” between the poles of liberal and conservative, focuses more on collaboration and less on the competitive principles of the previous internal-market reforms of Britain’s Conservative government. In this paper Julian Le Grand discusses “the evidence concerning the internal market’s effectiveness,” building on a paper published in Health Affairs last July (Rudolf Klein, “Why Britain Is Reorganizing Its National Health Service—Yet Again”). Following Le Grand’s paper is a series of Perspectives, focusing both on the NHS reforms and on another endeavor under way in Britain: an attempt to address inequalities in health, based on a study of the social determinants of health and poverty. This discussion has implications for other health care systems as they seek to improve their citizens’ health in an era of cost constraints. Le Grand is Richard Titmuss Professor of Social Policy at the London School of Economics and holds a doctorate in economics from the University of Pennsylvania. He has served as an adviser to the World Bank and the European Commission, and is prominent in Britain as an advocate of the “third way.” © 1999 The People-to-People Health Foundation, Inc. INTERNATIONAL 27 REFORM HEALTH AFFAIRS ~ May/June 1999 BRITAIN Downloaded from HealthAffairs.org on May 31, 2020. Copyright Project HOPE—The People-to-People Health Foundation, Inc. For personal use only. All rights reserved. Reuse permissions at HealthAffairs.org.