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The Maynard Doctrine - Two Christmas debating issues

Professor Alan Maynard suggests that ‘tis the season for discussion

1) Do specialist hospitals need super-subsidy?
Specialist hospitals are supposed to benefit from economies of scale i.e. because they are big and specialised, surely their unit costs should be lower?

If these economies of scale exist, why are specialist hospitals such as Great Ormond Street Hospital, Alder Hey and the other hospitals in London and other cities given subsidies?

And what should we do if these economies don’t exist?

Here are two issues for debate as we enter the Christmas season.

2) What is the best way of altering clinicians’ behaviour? Should we pay 'em or flay 'em?
With the ‘flay 'em’ option unappealing on the grounds of cleaning and infection control (and some nonsense about human rights), can we alter clinicians’ behaviour with transparency of processes and outcomes that makes them more competitive to maintain their reputations?

Why pay 'em, when reputation policies may achieve even more?

What demonstrably works?

Both need evidence to resolve them - but equally, it would be nice to exchange opinion as to Health Policy Insight readers' views regarding these two questions.

Santa hats off and thinking caps on!

Send your comments, thoughts, quips and blandishments for publication, please, to the Health Policy Insight website email -

We may find a small token to acknowledge the brightest and best response.

Happy Christmas,

Alan Maynard