A range of views on the effects of competition in healthcare

The redistributive agenda behind market-based health care reform (Nuffield Trust: 1 May 1998)
Professor Evans argues that the evidence from market innovations over the last forty years demonstrates inferior system performance bringing greater inequity, increased inefficiency, cost inflation and higher levels of public dissatisfaction.

Competition is intrinsically wasteful (BMJ: 8 May 2012)
Consultant medical oncologist Michael Crawford presents his view on the spare capacity, or ‘waste’, which comes at the cost of the constant availability of services offered by a competitive healthcare. He argues that while competition in healthcare increases choice for patients and reduces waiting lists, it leads to wasted capacities and resources; a consequence he sees as often ignored.

Two issues with competition in healthcare (BMJ: 2011)
Research fellow Lucy Reynolds presents two issues in competition in healthcare. Firstly, she argues that fees for services result in overtreatment and undertreatment of certain patients: those who can pay end up getting treatment that they do not necessarily need, while those who cannot pay may lack much needed treatment. Secondly, according to Reynolds, fees for services combined with patients’ trust in doctors leads to ‘supplier induced demand’; healthcare in which the demand is not determined by the patients.

Competition in healthcare can help to save lives, study concludes (BMJ: 2011)
A study by Zack Cooper from the LSE showed that ‘competition among hospitals in England led to a 7% fall in the number of deaths from acute myocardial infarction over three years, saving around 900 lives.’ However, Cooper’s interpretation of this statistic, that competition leads to a better hospital performance, has been criticised. Professor Allyson Pollock and Anna Dixon from the King’s Fund, for instance, claim that the lower mortality rates had not been a result of more patient choice or competition, but other factors such as improved screening by GPs and new non-surgical procedures.

Preliminary findings on competition in healthcare should not be over-interpreted (BMJ: 2011)
Professor Nick Black calls for additional research for more convincing evidence for the link between care quality and competition. Black states that much of the research has focused only on one aspect of care quality – safety, ignoring other aspects such as effectiveness, experience and equity. Black suggests that research must be conducted in other clinical areas using data that are not subject to the limitations of hospital episode statistics.

Is there evidence that competition in healthcare is a good thing? Yes (BMJ 2011)
Simon Stevens, president of the global health division at United Health Group, argues that competition can be beneficial for healthcare, if implemented properly. He bases this view on figures indicating financial benefits for taxpayers and health professionals as well as improvements on hospital performance, productivity and equity.

Is there evidence that competition in healthcare is a good thing? No (BMJ 2011)
Professor of health policy Nicholas May counters Simon Stevens’s view by arguing that what has been considered as evidence of competition being beneficial is unclear and somewhat misleading. May argues, for instance, that after the introduction of patient choice for hospitals, the effects of competition were small. He also argues that declined mortality rates are not a fully comprehensive indicator of an improved overall healthcare performance. 

 
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