Efficiency in the National Health Service: lessons from abroad.

Although the NHS gives relatively good value for money when compared to other countries' health care systems, there are managerial initiatives from abroad that could potentially increase NHS efficiency. However, there is currently very little systematic evaluation of the impact of managerial interventions in terms of their benefits and costs. This paper considers four areas of current policy interest (evaluation of new medical technologies, quality assurance, primary health care and the public/private mix), reviews experience abroad and outlines how promising initiatives could be evaluated in the NHS setting. It is argued that if lessons are to be learned about the efficient management of the NHS from abroad or not, there needs to be more systematic evaluation of managerial interventions along the lines commonly proposed for clinical interventions.