Is there evidence that competition in healthcare is a good thing? Yes.

نویسنده

  • Simon Stevens
چکیده

The coalition government’s approach to competition in the English NHS represents a shift to a more systematic attempt to organise the NHS along the line of the former publicly owned utilities. There is to be supplier competition both in the market (providers seeking individual patients) and for the market (commissioners selecting providers for services to populations). But the market for tax financed, largely free at the point of use healthcare provided by strongly regulated professionals differs markedly from, for instance, the gas and telecommunications markets. Not only is public healthcare the subject of intense public and political concern, the quality of much care is difficult for users to assess, and most of the time patients are dependent on the doctor to act as their agent. As a result, standard market theory produces ambiguous predictions of the likely effect of competition. A recent review of international evidence on the effect of supplier competition in healthcare concluded that it is complex and equivocal. It is also challenging to implement and regulate competition, generating considerable transaction costs. Competition is clearly easier to apply to services such as elective surgery or routine diagnostics that are episodic, are relatively easier to define, and have outcomes that are more straightforward to assess. Competition between providers is also likely to have more predictably desirable effects when prices are set under a prospective payment system (such as the NHS payment by results system) rather than when they are allowed to vary. UK evidence

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Competition in Healthcare: Good, Bad or Ugly?

The role of competition in healthcare is much debated. Despite a wealth of international experience in relation to competition, evidence is mixed and contested and the debate about the potential role for competition is often polarised. This paper considers briefly some of the reasons for this, focusing on what is meant by “competition in healthcare” and why it is more valuable to think about th...

متن کامل

Optimisation of Healthcare Contracts: Tensions Between Standardisation and Innovation; Comment on “Competition in Healthcare: Good, Bad or Ugly?”

An important determinant of health system performance is contracting. Providers often respond to financial incentives, despite the ethical underpinnings of medicine, and payers can craft contracts to influence performance. Yet contracting is highly imperfect in both single-payer and multi-payer health systems. Arguably, in a competitive, multi-payer environment, contractual innovation may occur...

متن کامل

It’s More Complicated than That; Comment on “Translating Evidence into Healthcare Policy and Practice: Single Versus Multi-Faceted Implementation Strategies – Is There a Simple Answer to a Complex Question?”

In this commentary the findings from a systematic review that concluded there is no compelling evidence to suggest that implementing complicated, multi-faceted interventions is more effective than simple, single component interventions to changing healthcare professional’s behaviour are considered through the lens of Harvey and Kitson’s editorial. Whilst an appealing conclusion, it is one that ...

متن کامل

It Is Not That Simple nor Compelling!; Comment on “Translating Evidence Into Healthcare Policy and Practice: Single Versus Multi-faceted Implementation Strategies – Is There a Simple Answer to a Complex Question?”

Healthcare decisions are often made under pressure, with varying levels of information in a changing clinical context. With limited resources and a focus on improving patient outcomes, healthcare managers and health professionals strive to implement both clinical and cost-effective care. However, the gap between research evidence and health policy/clinical practice persists despite our best eff...

متن کامل

“Horses for Courses”; Comment on “Translating Evidence Into Healthcare Policy and Practice: Single Versus Multi-Faceted Implementation Strategies – Is There a Simple Answer to a Complex Question?”

This commentary considers the vexed question of whether or not we should be spending time and resources on using multifaceted interventions to undertake implementation of evidence in healthcare. A review of systematic reviews has suggested that simple interventions may be just as effective as those taking a multifaceted approach. Taking cognisance of the Promoting Action on Research Implementat...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • BMJ

دوره 343  شماره 

صفحات  -

تاریخ انتشار 2011