Managing medicine: a response to the 'crisis'.

A feature of many developed healthcare systems is the attempt to replace provider-driven services by managerially-driven services which are ostensibly more responsive to consumer preferences. Policy-makers anxious over the 'crisis' of escalating costs in healthcare delivery and over the efficiency of some medical treatments and interventions are turning to managerial solutions as a means of holding professionals--primarily the medical profession--to account for their actions. The paper uses developments in the British NHS as a case study to review and explore the issue of managing medicine. Recent and proposed reforms are designed to strengthen the managerial grip on the service. The paper casts some doubt over the likely outcome of these developments. It argues that the success of attempts to shift the frontier between management and clinical work in favour of management is by no means guaranteed. It also points to a major tension which remains to be resolved, namely, the optimum balance to be struck between a doctor's responsibility to each individual patient on the one hand and his/her responsibility to a whole population on the other.