The United Kingdom: Effective, Efficient, Equitable

to make health care available to all regardless of income, and it has managed to achieve this goal while keeping costs lower as a proportion of the gross domestic product than many Western countries and at the same time assuring equitable distribution of re-sources regionally. Until the reforms introduced by the 1989 White Paper, the NHS was characterized by centralized financing and regulation; despite some problems in the delivery and management of care, the system was a popular one. The new re-forms hope to enhance efficiency in the NHS by stimulating competition and further decentralizing the management of health care. However, it is not at all certain that in practice the reforms will have the desired effect. Initial costs will be high, people may not respond to incentives as predicted, and the quality of care and access to it could well deteriorate. Nations planning to use the U.K. system as a model are advised to use caution. Four countries-England, Wales, Scotland, and Northern Ireland-corn-prise the United Kingdom of Great Britain and Northern Ireland. There are differences in organization and per capita funding among the four, but the key features of the National Health Service (NHS) are the same throughout the kingdom, and for the most part, this paper will deal with the U.K. as a whole. The NHS was founded in 1948. The 1944 White Paper of Churchill’s wartime coalition government stated that the goal of the NHS was “t