CLASSIFICATION PROBLEMS AND THE DIVIDING LINE BETWEEN GOVERNMENT AND THE MARKET: AN EXAMINATION OF NHS FOUNDATION TRUST CLASSIFICATION IN THE UK

ABSTRACT: In this paper we argue that national accounting categories provide an inadequate basis for evaluating differences between public and private sector services. This is because accounting categories rely on economic concepts such as market price but do not take account of substantive public policy goals such as universality. The argument has important consequences for the structures and systems of delivery especially where nonprofit providers and social enterprise models are substituted for public bodies formerly integrated into the government's delivery system. Using an example taken from the UK's National Health Service, we show that the mechanisms for ensuring universality through redistribution are not sufficiently taken into account for classification purposes.     

Pump-Priming the PFI: Why are Privately Financed Hospital Schemes Being Subsidized?

The authors explain how the Private Finance Initiative (PFI) has raised the costs of infrastructure development in the health service. They demonstrate that the assumption that higher capital costs would be offset by savings resulting from the involvement of the private sector is wrong—rather, NHS trusts and health authorities have been obliged to make savings on other budgets in order to make the high costs of investment affordable. There is no reason to believe that these problems will disappear as the volume of PFI investment increases.     

Comparing adolescent-focused obesity prevention and reduction messages

Drug abuse, smoking, and disordered eating literature reveal that some health promoting messages can induce unintended or harmful effects on the target audience. Scholars recommend careful messaging in social marketing campaigns, by shifting the focus away from health outcomes. This study tests the effects of adolescent-targeted obesity prevention messages (body-image, health benefit) with positive experience and unrelated messages on health behavior intentions and unintended effects. A pre-post experiment (N = 95) reveals that body-image public service advertisements (PSAs) may increase anxiety when compared to unrelated PSAs (no main effect, significant planned comparisons are found). Health benefit PSAs are more readable (F = 4.59, p < .05) than all other PSA groups and show higher healthy eating planning (F = 3.19, p < .05) compared to unrelated ones. No significant weight attitudes, self-esteem, and stages of change differences are found by message type. Overall, health benefit messages are not less effective.     

Capital Investment in Primary Care—The Funding and Ownership of Primary Care Premises

The authors describe the complexity of the financing arrangements of primary care premises. They explain how the early vision of integrating health and social services within local health centres failed to be realized, with GP-owned practice premises remaining as the dominant model. There was a switch to private finance when the government loan body (General Practice Finance Corporation) was privatized in 1989. Although capital can now be freely raised by the private sector for investment in the National Health Service (NHS), these debts have to be repaid through NHS funds or user charges. The complexity, combined with demographic factors, makes it likely that as GPs opt for the Personal Medical Services (PMS) scheme and a salaried service, the trend towards for-profit corporations owning and buying out GP premises will accelerate.     

THE PRIVATE FINANCING OF NHS HOSPITALS: POLITICS, POLICY AND PRACTICE

This article outlines and critiques the main fiscal and economic rationales for the Private Finance Initiative and examines the impact of the policy on the long-term financial viability of NHS trusts. It concludes that the PFI funding of capital investment is highly problematic. Its high costs can have a negative impact on the finances of health systems.