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<p>Retaining the purchaser provider separation has been the policy of successive governments.
In line with its predecessors, this Government considers it the most effective means
of developing efficient high quality care while providing value for money for the
public purse. More specifically, it created a means of managing the health service
in which providers of care were accountable to the public through contracts which
specified the quality of care, and its cost in a much more transparent way than had
previously been the case. In doing so, it also drove improvement in both the quantity
and quality of what the health service was providing.</p><p> </p><p>However, there
are two distinct reasons why it has often been difficult to quantify the relative
costs and benefits of the internal market. First, it is difficult to estimate the
cost of what would have happened without it – in other words what would have been
the case had such accountability not been in place. Second, there have been differing
models for implementing the internal market over at least two decades (total purchasing
pilots, general practitioner fundholding and practice-based commissioning).</p><p>
</p><p>The impact assessment for the Health and Social Care Act 2012<sup>1</sup> looked
at the broad cost and benefits of continuing a separate commissioning function as
an advocate for patients and the taxpayer, separate from the more autonomous provider
side.</p><p> </p><p><em>Notes:</em></p><p><sup>1</sup>www.gov.uk/government/uploads/system/uploads/attachment_data/file/215819/dh_129916.pdf</p>
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