Those practitioners will have an easier time determining which hospital or private providers to work with. Mergers between hospital groups are occurring for the same reasons they do in the States -- the economy of scale and group purchasing power lowers costs and increases profit. However, these consolidations and mergers haven't received an enthusiastic response from the government. "The government sees hospitals inefficient and often poorly managed with their own special interests," said Pringle.

Still, the monolithic government isn't doing any better. "Every few years, the new government decides the NHS is the wrong structure. It's a continual struggle with the cost going up, but no real improvement to efficiency," said Pringle.


Equipment and maintenance
Unlike the U.S. where individual hospital and hospital groups make the decision to purchase equipment for any number of reasons -- improved patient care, preferences by staff, marketing opportunities, or squeezing out competition -- the U.K. has just one consideration when determining a purchase: prove the equipment is going to do the job it needs to do. "Manufacturers find it very difficult to get new equipment into facilities," said Pringle. "They can't effectively influence individual hospitals and there is less equipment overall. If you look at scanners by population, it is way less than the U.S. California probably has three times the number or MRIs than the U.K."

With less equipment, there's also less for service organizations to work with. "OEMs have had 100 percent market share of the sales and maintenance but this is changing rapidly. But there's a centralized procurement process for manufacturers for all NHS hospitals," said Pringle. Hospitals procure what they want or can afford and centralized procurement drives the equipment prices down based on volume. This will also shortly apply to maintenance programs, allowing ISOs into the market, according to Pringle.

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