Criticism of market-based approach to service delivery and structure

If criticism grows of the application of health economics and cost-benefit approaches, pressures may grow to develop alternative approaches.

Efforts to rationalise decision making through the application of health economics and cost-benefit approaches have gained footholds in many areas of health management. However, these efforts are often contested in terms of specific applications (as in campaigning against specific NICE decisions). In another example it is also unclear how commissioning through Any Qualified Provider (AQP) will affect service delivery including health promotion and awareness in the public health domain. There are implications in the current financial climate that overall in health care AQP may lead to driving down costs at the expense of quality. This may have implications for long term workforce planning and training as higher degrees of uncertainty will emerge in a more competitive environment.
Several factors could lead to more challenges to these methods, including:

  • multiculturalism, where different communities have differing values attached to various aspects of life
  • recognition that public health involves informal care with burdens very unevenly distributed (e.g. across gender and income levels)
  • extreme cases where application of these methods results in highly publicised anomalies.

Efforts to develop alternative methods and/or to shore up these techniques may take different forms. Therefore, different communities may in practice develop their own approaches, leading to public health and commissioning professionals requiring training in different approaches, and managers having to confront departures from universalism and difficult questions where individual responsibility is seen to play a role in ill health (e.g. smoking, obesity).
This might be seen as part of a shift away from modern assumptions of universal rationality to postmodern experimentation with multiple approaches. On the other hand, a new ethics-of-care approach might be consolidated; it is highly likely that much more attention will be given to ethics in public health in coming years. Note: These public health ideas are liable to be pervasive but may become especially difficult where emergencies create needs for triage or very uneven distribution of resources.

Related Sectors Related Specialities

  • Healthcare
  • Public health
  • Allied health professionals
  • General practitioners
  • Hospital doctors

Related Themes Related Projects

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Key facts

Analysis

Forward looking advice

Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.

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