HMOs in the U.S.A. and Britain: A new prospect for health care?

The Americanization of the British National Health Service: A typological approach

“…A number of commentators (e.g. Freeman, 1999;Marmor & Plowden, 1991;O'Neill, 2000;Rayner, 1988) pointed out that the debate drew heavily on the ideas of the American economist, Alain Enthoven (1985, p. 42), who suggested an "internal market" based on District Health Authorities. However, while Enthoven believed that this would offer "substantial improvements" over the present NHS structure, it would not promise the full benefits of the kind of competing HMO structure that was developing in the US.…”

“…As Rayner (1988) stressed, Enthoven personally favoured the model of the corporate HMO, but in the British context promoted "market socialism" of a more competitive environment between health districts as a second-best alternative. Rayner went on to discuss "primary care HMOs" similar to the ones British health economist Alan Maynard had suggested.…”

“…Policy learning or borrowing: ideas Enthoven (1985), Rayner (1988), Marmor & Plowden (1991), Freeman (1999), O'Neil (2000 • "competitive market" (Enthoven, 1985) • Enthoven's pro-market ideas represented "an instance of almost pure theory being transplanted across an ocean" (Marmor & Plowden, 1991, p. 812). • What was transferred was not an established institution or program but rather a general set of ideas (O'Neill, 2000, p. 67).…”