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"Liberalizing" the English National Health Service: background and risks to healthcare entitlement

Lookup NU author(s): Professor Allyson PollockORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


The recent reform of the English National Health Service (NHS) through the Health and Social Care Act of 2012 introduced important changes in the organization, management, and provision of public health services in England. This study aims to analyze the NHS reforms in the historical context of predominance of neoliberal theories since 1980 and to discuss the "liberalization" of the NHS. The study identifies and analyzes three phases: (i) gradual ideological and theoretical substitution (1979-1990) - transition from professional and health logic to management and commercial logic; (ii) bureaucracy and incipient market (1991-2004) - structuring of the bureaucracy focused on administration of the internal market and expansion of pro-market measures; and (iii) opening to the market, fragmentation, and discontinuity of services (2005-2012) - weakening of the territorial health model and consolidation of health as an open market for public and private providers. This gradual but constant liberalization has closed services and restricted access, jeopardizing the system's comprehensiveness, equity, and universal healthcare entitlement in the NHS.

Publication metadata

Author(s): Filippon J, Giovanella L, Konder M, Pollock AM

Publication type: Article

Publication status: Published

Journal: Cadernos de Saúde Pública

Year: 2016

Volume: 32

Issue: 8

Print publication date: 01/08/2016

Online publication date: 29/08/2016

Acceptance date: 24/06/2016

Date deposited: 21/12/2017

ISSN (print): 0102-311X

ISSN (electronic): 1678-4464

Publisher: Escola Nacional de Saude Publica (Brazil)


DOI: 10.1590/0102-311X00034716

PubMed id: 27580231

Notes: Also published in Portuguese


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