The illnesses of Elizabeth Barrett Browning.

Access to health care While competition may yield efficiency gains there is always a danger that without safeguards these will be achieved at the expense of a loss of equity. Services offering clear revenue earning potential will become more attractive. Many health promotion and screening services-primarily aimed at the affluent, worried well-are likely to fall into this category. Similarly, it will be easy to draw up service contracts for well defined, short stay, minor elective surgery. Providing long term care for the mentally ill and handicapped, the chronically sick, or for elderly people suffering from dementia may hold less attraction as a source of revenue. Access to services will also be influenced by the location of services resulting from the competitive process. If competition leads to greater specialisation and the concentration of services at fewer sites there will be greater need for some patients to travel further for treatment. This might penalise less mobile people and their families. Continuity of care after hospital discharge for those patients treated outside their home districts may also be a problem. Liaison between hospitals and local general practitioners, social service departments, and community services is already a cause of concern. Treatment at a distance might exacerbate these difficulties.