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Viewpoint | Health Care Reform

The Role of Government in Health Care Reform in the United States and England

Martin Marshall, MD1; Andrew B. Bindman, MD2,3
[+] Author Affiliations
1Department of Primary Care and Population Health, University College London, London, England
2Department of Medicine, University of California, San Francisco
3Department of Epidemiology & Biostatistics, University of California, San Francisco
JAMA Intern Med. 2016;176(1):9-10. doi:10.1001/jamainternmed.2015.6054.
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This Viewpoint addresses common challenges in the United States and England of increasing health care value by improving quality and discusses how governments have a central role in determining the public-private balance of their health systems.

In the past, stark differences between the pluralistic, market-driven health system in the United States and the single-payer, centrally managed system in the United Kingdom have resulted in rich opportunities for those interested in comparative health system analysis. These differences are real but look like they are becoming less marked as a consequence of recent trends toward direct governmental intervention in the United States and the use of market forces in the English National Health Service (NHS). In this respect, England contrasts markedly with the devolved nations of Scotland, Wales, and Northern Ireland, which to a greater or lesser extent have rejected a role for competition in their health services.

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