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In this report, part of the ASI's influential Road Map series, the authors seek to retain what is best about the NHS, in particular the fairness that it represents. The report is based on the principle that everyone should have high-quality healthcare free at the point of need, and assumes that most healthcare will continue to be funded through taxation. Nonetheless the authors also propose to unleash the power of enterprise and innovation in how healthcare is actually provided. This requires breaking through the ideological barricades - a public-private mixture is really the only way forward.

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This report, which calls for an end to today's centralised health service and the adoption of competing european style social insurance has been endorsed by prominent health experts. The main thrust is that the government should neither provide nor finance health. It should mearly regulate. Instead hospitals and doctors should be made fully independant of whitehall, as local trusts. Families would subscribe to one of a number of social insurers, who would then buy the services from one of the indeependant providers. Ex- minister Frank Fields says that "if the present government's reforms do not soon show signs of success, a system of competing health suppliers regulated by government and run on insurance lines will begin to be practical politics."

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People in good health should be able to get part of their taxes back and take the money to a private health insurer or company health plan, according to actuary and City University professor Philip Booth in a new report for ASI. This would give patients better choice, driving down costs and driving up quality as new healthcare providers bid for their custom.

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Neither the NHS nor private health insurance plans run efficiently because neither adequately reflect demand of medical services. In both schemes there is no connection between usage and cost of services to the consumer, creating an over-demand for services. Attempts have been made to curb this problem by private insurers in the use of co-payments or other means of sharing service costs with consumers. This paper contends that independent Medical Savings Accounts, paid into by the employer but under the control of the consumer will sovle this problem by providing resources for care, but creating incentives for patients to use only the services they require.

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A new ASI report suggests that Britain should follow Sweden, Norway, Holland and Belgium in asking people to pay the first £60 of their annual prescriptions bills. This would bring an extra £2 billion into the NHS, cut the waste of 'free' medicines that are never taken, and would allow patients to weigh up whether expensive new medicines – unavailable on the NHS today – were really worth paying for. Is £60 too much? It's only a sixth of what the poorest families already spend on booze, betting and baccy, says author Ian Senior.

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Britain's tax funded health system is no longer the world's envy, but a quaint oddity. It will remain in financial crisis until we bring far more private spending on healthcare. Health costs cannot be met by taxation alone. The Institute highlights three areas where funding could be changed. The first is competing funds where 'NHS tax' contributions are paid into a number of 'social insurance funds' of their own choice. The second is charges where there should be co-payments for some minor services, as already happens in Europe. The third is cost, taking the responsibility for healthcare funding out of central government and handing it to private or non profit social insurance funds, will increase what we spend on healthcare.

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Professor Alain Enthoven is one of the world's leading health policy analysts. In this paper for ASI, he reflects gloomily on the prospects for real improvements in NHS delivery unless there are more radical reforms than the politicians are contemplating.

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The regulation of clinical practice must focus on the clinical service standards that are delivered to patients, and not on protecting professional self-interest. It must be accepted and trusted as such by the public. We envisage therefore a single regulatory authority that is independent of the healthcare professions. It should be dominated by lay representatives, and perhaps chaired by a lawyer rather than a clinician.

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5 per cent of doctors are estimated to be making the wrong decisions - that amounts to 5,000 doctors with 100,000 patients. There is a need for improved regulation of the medical profession with the emphasis centred on the patient. Currently the public is untrusting of the medical profession, This briefing paper sets out guidelines for a new shape to regulation.

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