Purchasing

Abstract

The decision to introduce an internal market based on the division between the purchaser and provider of health care brought into sharp focus the key political problem of the NHS: that the demand for health care will always exceed the supply, that a rationing mechanism is therefore required to resolve the difference between the two, but that the explicit rationing of resources is unacceptable to the health care rights embodied in the concept of British citizenship. In the past the resolution of this conundrum was achieved covertly: rationing took place, but it was in no-one’s interest to advertise the fact. What the reforms have achieved is the creation of a role, that of the purchasing agent, which takes clear and unequivocal responsibility for the allocation of resources, which must, given excess demand, make overt choices about the rationing of scarce resources and which will, inevitably, conflict with the universalistic values of the welfare state.