The new information management and technology strategy of the NHS.

provident societies. The guidelines and schedules were produced in 1989, and data collected by the commission show a wide variation in charges before 1989 and a convergence thereafter. In March 1989, for instance, surgeons' charges for a coronary bypass graft operation varied from £175 to £4000, with £1500 being levied on 11 occasions and £1600 on nine occasions. In March 1992 surgeons charged £2000 on 108 occasions, £1950 on 11 occasions, and £2200 on 10 occasions. The maximum suggested by the British United Provident Association was ,£2000; 56% of surgeons charged that price, and 46% of anaesthetists charged £825, the maximum price suggested for them. The case has been made that the guidelines have a strong impact on the price, and the BMA accepts that a complex monopoly exists within the definitions used by the commission. The BMA does not accept, however, that this impact is not in the public interest; it believes that patients should be making their choice on grounds of quality rather than cost. For most economists it is an article of faith that impediments to a free market are a bad thing and that the commission should take some action. The remedies it is considering include prohibiting the BMA from publishing its guidelines and prohibiting insurers from reimbursing claims according to a schedule of procedures. Responses must be in by 4 August, and a final report will be produced probably early next year. Whatever happens, private medicine will remain a long way from being a perfect market, although patients will benefit the closer we come to one.