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In the 1991 National Health Service reforms, health authorities became responsible for the health of their resident population, and they contract for health services from NHS providers - trusts and primary care services. A case study in Camden and Islington, an inner London health district, during 1996-1997 shows that contracting was directed more towards achieving financial balance than health objectives. Reasons include the inflationary effect of competition within an internal market, the power of administrators in decision-making within the health authority, and lack of adequate financial accounting in the NHS to relate costs to health outcomes. The introduction of programme budgets for districts would provide more cost-effective use of the nation's resources.

Original publication




Journal article


Journal of public health medicine

Publication Date





409 - 413


Department of Public Health, University College London.


Humans, Urban Health Services, Cost Control, Budgets, Contract Services, Health Planning, State Medicine, London