Published: 24/07/2003, Volume II3, No. 5865 Page 22
A World Bank publication argues that corporate-run health services can still be 'national', but governments must learn to 'let go'
Innovations in Health Service Delivery The corporatization of public hospitals
By Alexander Preker and April Harding Published by: World Bank Publications.
ISBN: 0821322943 $40 (£23.98 on www. amazon. co. uk)
The debate about foundation hospitals has so far been full of sound and fury, with a notable lack of sensible, critical analysis, particularly from the opponents of reform.
This book from the health team at the World Bank arrives at the perfect moment to contribute both some rationality and an international perspective. It is a comprehensive review of the experiences of many countries in 'corporatising' healthcare provision - handing it over to either non-profit organisations or to commercial, for-profit companies.
Of course, the World Bank ('Reform club', news focus, pages 13-14, 15 May) has something of a reputation for pursuing a fairly right wing financial and political agenda, in which privatisation and free markets are the solution to any ills that befall a nation.
Some will view this book with suspicion as a result - and it is true that the overall tone is somewhat dismissive of the benefits of publicly run health services. There is also too little acknowledgement of the problems involved in getting some of these reforms to work.
Moreover, the book is a daunting tome - at over 600 pages it is nearly as long as the latest Harry Potter and somewhat less readable.
Few readers are likely to wade through the whole thing, but those who tackle at least the key chapters will find them rewarding and illuminating. Nowhere else will you find such a careful, authoritative analysis of the experience of many other countries where the delivery of healthcare has been placed in the hands of independent or autonomous nongovernmental providers.
The book begins with a comprehensive overview of marketisation and corporatisation reforms in healthcare, and then offers a series of case studies of reform in countries as diverse as New Zealand, Hong Kong, Ecuador, the UK, Tunisia and Australia.
Not all are tales of success, but then as former NHS chief executive Sir Alan Langlands observes in the foreword, if the book can help policy makers to avoid the mistakes and pitfalls that others have encountered in the past, it will have made a real contribution to international health reform.
The book has two key messages for the current foundation hospitals debate.
First, it argues that all over the world, governments are getting out of direct involvement in healthcare delivery and handing the job over to others while still retaining responsibility for funding and regulation.
In other words, we can still have a national health system, funded through taxation, with foundation trusts running healthcare provision. Indeed, That is how most countries do things.
Secondly, it suggests that to make corporatisation reforms work, governments have to let go - not just pretend to do so.
They have to hand over control and not yank it back again when its politically convenient to do so, or try to direct events by pulling the regulators' strings.Whether this government has the courage to let foundation trusts go remains to be seen.
No comments yet