The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64206

Marilyn Ann DeLuca, PhD, RN, Departmment of Psychiatry, New York University, School of Medicine, 335 East 18th Street, New York, NY 10003, 212-228-6714, rodesch@att.net

I. The UK’s National Health Service (NHS) 1991 reforms [data 1986-1997] and US Veterans Health Administration (VHA) 1995 reforms [data 1991-1998] were examined. NHS reforms were based on managed competition and a market-model of public administration; VHA reforms relied on managed care strategies and a deregulation model of governance. Questions studied: (1) What (a) societal values, (b) political conditions, (c) institutional contexts shaped reforms and implementation? (2) How did reforms impact shared missions: service, education; research? (3) Did reforms achieve stated goals? (5) What are the reform byproducts? II. This multiple case-study employed mixed-methods- triangulation of qualitative and quantitative methods; primary (semi-structured interviews; contacts; participant-observer experiences) and secondary data (documents; policies; databases; publications), and content, discourse and descriptive analytic methods. III. Distinct socioeconomic and political factors opened windows for reform; strategies and impacts varied. NHS reforms were process-based and relied on an internal market; VHA reforms were results-oriented and used performance measures. New organizational structures were introduced- NHS became purchaser-driven; VHA manager-dominated. Compared with pre-reform trends, NHS services and staffing data demonstrate little change; VHA data changed significantly. Both adopted cost-cutting strategies. Byproducts include shift of power to management; decreased access for some patients; altered ‘mission-balance’. IV. Implications: (1) economic constraints prompt perverse incentives; (2) reforms need built-in accountability; (3) short-term reform should support long-term public health goals; (4) accommodation of professionals depends on politico-cultural history and context; (5) market-based reforms in fixed-budget settings can undermine service, access, missions, morale; (6) reform, often incremental, marks the start of long-term change.

Learning Objectives:

• At completion of this session, the participant will be able to:
• (1). Describe three factors that respectively influenced the NHS and the VHA health reforms and implementation strategies.
• (2). Articulate two key reform strategies for each the NHS and VHA reforms.
• (3). Identify three changes in health service delivery affected by the NHS and VHA reforms.
• (4). List four byproducts of the reforms in the NHS and VHA.
• (5). Discuss three public health implications for health systems under-taking reform.

Keywords: Health Care Reform, International Public Health

Related Web page: (www.proquest.com) (http:/endowment.pwcglobal.com/pdfs/DeLucaReport.pdf)

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: retired from VHA and receive government annuity; dissertation research supported in part by a small grant from PriceWaterhouse Coopers Endowment