This paper is the text of the 1994 Francis Fraser Lecture given at the Royal College of Physicians on 2 June 1994. It presents the outcome of the consultation exercise conducted by the taskforce on R&D in the NHS chaired by Professor Culyer and identifies the principle problems currently...

The concept of skill mix is widely recognised in the vocabulary of the National Health Service (NHS) workforce but because of its complexity is understood, elusive to define and therefore difficult to measure. Many issues surround the concept of skill mix, some of which are concepts in their own...

This paper presents new evidence on the determinants of starting and quitting smoking using duration data from the British Health and Lifestyle Survey (HALS). Self-reported data in individual smoking histories coupled with availability of a long time series for the tax rate on cigarettes are...

Critical leg ischaemia can be treated by amputation of the affected leg or by reconstruction of the arteries. Arterial reconstruction is perceived to be an expensive procedure, often requiring more than one operation, which does not always prevent amputation. However, amputation is associated...

In December 1994 the Department of Health published guidelines intended to inform participants in the NHS internal market of current government policy with respect to mergers and anti-competitive behaviour. The Guide focused on four topics: provider mergers and joint ventures, providers in...

The latest return to service planning in the NHS, while harnessing the perceived benefits of previous market approaches, nevertheless signals a radical change in the long-term role of the Health Authority. It is timely to examine the actual objectives of Health Authorities in view of their...

The English Department of Health has introduced routine collection of patient-reported health outcome data for selected surgical procedures (hip and knee replacement, hernia repair, varicose vein surgery) to facilitate patient choice and increase provider accountability. The EQ-5D has been...

Accounting for variation in the quality of care is a major challenge for the assessment of hospital cost performance. Because data on patients’ health improvement are generally not available, existing studies have resorted to inherently incomplete outcome measures such as mortality or...

The general issue of balancing the value of evidence about the performance of a technology and the value of access to a technology can be seen as central to a number of policy questions. Establishing the key principles of what assessments are needed, as well as how they should be made, will...

We apply cross-sectional and panel data methods to a database of 5 million patients in 8,000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is...