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Alternatives to fundholding

Glennerster, Howard, Cohen, Anna and Bovell, Virginia (1998) Alternatives to fundholding. International Journal of Health Services, 28 (1). pp. 47-66. ISSN 0020-7314

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Identification Number: 10.2190/E5MT-HHGH-5AAA-RC1X


The new Labour government in the United Kingdom is proposing to adapt the reforms begun by the last Thatcher government. In particular, it is proposing to abolish the most controversial element—general practitioner (GP) fundholding. It is looking for alternatives. The study reported here followed and evaluated several such schemes. While fundholders use their purchasing power directly to force change by threatening "exit" to another provider, other GPs have evolved ways of influencing decisions—enhancing their "voice." The authors develop a theory to predict the conditions favoring the relative success of exit and voice strategies in health purchasing, and describe alternative GP-based purchasing schemes and the reasons they evolved in six sample districts. In four of these districts and eight practices in each, fundholding and non-fundholding GPs were then asked to describe their intentions and the outcomes of the purchasing process in which they had participated. Four specialties were taken as examples. The authors compare the relative success of fundholders and non-fundholders in achieving their objectives.

Item Type: Article
Official URL:
Additional Information: © 1998 Baywood Publishing Co., Inc.
Divisions: Social Policy
Centre for Analysis of Social Exclusion
Subjects: H Social Sciences > HC Economic History and Conditions
H Social Sciences > HJ Public Finance
H Social Sciences > HV Social pathology. Social and public welfare. Criminology
R Medicine > RA Public aspects of medicine
Date Deposited: 06 Jun 2008 14:56
Last Modified: 31 Mar 2024 00:48

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