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

Abstract

There have been many different claims that the British National Health Service (NHS) is becoming 'Americanized'. Focusing on the United Kingdom, this article critically analyses the "Americanization" of the NHS in three main sections. First, we explore the basic meanings of the term. Second, we examine the development of the discourse about Americanization. Third, we focus on one of many possible meanings of Americanization, namely system change. Focusing on this most demanding dimension of Americanization, we suggest that most changes have been 'internal changes of levels' (where there is a shift of levels in one or more dimensions but without changing the dominant form) or 'internal system changes' (where only one dimension changes its dominant form) rather than a 'system change' (from one ideal type to another).

Conflict of interest disclosure: striking a balance?

“…As is typical in the 'Americanization' of debates [36], a point missing at the onset is that health care is a classical example of market failure in economic theory, since health is a 'merit good' rather than a common 'consumer good' [37]. This justifies the 'principal-agent' role played by physicians with patients in deciding therapies and that of third-party payers in mainly funding health expenses.…”

Competition in health markets: is something rotten?

“…The ‘forerunner’ reform in Europe consistent with this theory was the introduction in the early 1990s of the so-called ‘internal market’ in the British National Health Service 5 – the most widely acknowledged public healthcare system in the world – by splitting health authorities into ‘purchasers’ and ‘providers’ to foster competition among the latter. This move towards a market-oriented system potentially including private providers has often been mentioned as an ‘Americanisation’ of the National Health Service, 6 since the prevalence of private ‘players’ in the US makes this health system peculiar among most developed countries. The strategy has evolved into a process of privatisation by stealth – subcontracting out an increasing number of services in health.…”