Devolution and health in the UK: policy and its lessons since 1998.

INTRODUCTION: Since devolution in 1998, the UK has had four increasingly distinct health systems, in England, Northern Ireland, Scotland and Wales. SOURCES OF DATA: Secondary literature and authors' own research since 1998. AREAS OF AGREEMENT: From a similar starting point, there has been a considerable distancing of the four health systems from each other in policies, priorities and organization. AREAS OF CONTROVERSY: The comparative efficiency and quality of the different systems as well as the wisdom of their greater or lesser reliance on integration and competition. GROWING POINTS: Better and more comparable public data would be useful, as would consideration of potential devolved lessons for UK policy. AREAS TIMELY FOR DEVELOPING FURTHER RESEARCH: Comparisons of organization and performance at levels more detailed than whole systems; analysis of the resilience and management of different systems in a context of budgetary austerity; analysis of the politics behind policy decisions.