HealthcarePapers 16(1) July 2016 : 16-20.doi:10.12927/hcpap.2016.24768

What Can We Learn from the UK’s “Natural Experiments” of the Benefits of Regions?

Gwyn Bevan


Marchildon highlights the lack of evidence on policies of regionalization in Canada: with regionalization being in favour in the 2000s followed by disillusion and the abolition of regions by some provincial governments. This paper looks at evidence from the UK's single-payer system of the impacts of regions on the performance of the delivery of healthcare. In England, regions were an important part of the hierarchical structure of the National Health Service (NHS) from its beginning, in 1948, to the introduction of provider competition, in the 1990s. Since then, in England, governments have understood that the NHS cannot be run from Whitehall and have tried to replace hierarchical control by provider competition. The consequence was that regions in England were subjected to frequent reorganizations from the mid-1990s with their abolition being announced in 2010. In contrast, the devolved countries of the UK have always been organized as "regions" in the form of their historic national boundaries. This paper argues that changes in the NHS in the UK in the 1990s and 2000s offer three "natural experiments," in terms of funding, organization and models of governance, that give evidence of the impacts of stable regions in the UK. It also considers the lessons of this evidence for Canada.



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