Comparative case studies on the impact of health reforms in England


The Department of Health’s Policy Reform Programme aims to evaluate the effects of recent health care reforms in England, such as Patient Choice, Payment by Results, provider diversity, and new frameworks for regulation and decision making. The research will consist of comparative local case studies using a mix of documentary, quantitative and qualitative data. The research will contribute to both formative and summative evaluation,


The main aim of the project is to examine the interactions between these different reform mechanisms.  The objectives of the project are to:

  • Explore empirically how complex policy initiatives are being operationalised (implemented) within a range of local health economies (contexts), including how these local implementations are intended to operate (process) and their observed effects (outcomes).
  • Identify the extent to which policy initiatives are proving effective in addressing specific local issues in a range of tracer conditions / service specialties. (orthopaedics, diabetes, and mental health) – this will assess the impact on the interactions and dynamics within organizations as well as between them.
  • Provide policy-makers and practitioners with timely, formative feedback on good practice in implementation.
  • Actively disseminate findings within policy, managerial and academic communities.


Final report: 'Comparative case studies of health reforms in England' - report submitted to the Department of Health Policy Research Programme (PRP) (PDF)




Martin Powell, Ross Millar, Abeda Mulla, Hilary Brown, Chris Fewtrell (Birmingham School of Medicine), Hugh McLeod (King's Fund), Nick Goodwin, Anna Dixon and Chris Naylor


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