The new model NHS: performance, perceptions and expectations.

OBJECTIVE: This article analyses the transformation of the National Health Service (NHS) in England from a command-and-control to a mimic market model. AREAS OF AGREEMENT: Even while introducing market incentives and encouraging private providers, the new model preserves the essential characteristics of the NHS as a universal, tax-funded service free at the point of delivery. AREAS OF CONTROVERSY: The spectacle of famine among plenty -- service cutbacks at a time when the level of spending on the NHS is at a rate unprecedented in its history -- raises doubts about the competence of both local managers and central policy makers. Payment by results gives providers an incentive to maximize activity so prompting questions about the future rationing of resources and the role of the medical profession therein. AREAS TO DEVELOP RESEARCH: The implementation and effects of the policies already introduced and their modification in the light of experience.