Evaluating Health Care Reform: the Case of the NHS Internal Market

The NHS internal market, introduced in an atmosphere of controversy, continues to generate much disagreement. This article examines the evidence on the impact of this policy with regard to a range of criteria, including efficiency, accountability, effective planning and co‐ordination, patient choice and service quality, equity, and the culture of the NHS. It explores the different ways in which this evidence is perceived and seeks to make explicit the assumptions and biases of those involved in the debate about the reforms. The article also examines the policy process behind the reforms and the extent to which it has added to the problems of evaluation. By way of conclusion, the implications for future health care reform are considered and a number of procedural changes suggested.