Competition in Healthcare: Good, Bad or Ugly?

Document Type : Editorial

Author

Centre for Health Economics, University of York, York, UK

Abstract

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 the circumstances in which competition is more and less likely to be a good tool to achieve benefits, rather than whether or not it is “good” or “bad,” per se.

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Commentary Published on this Paper

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

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References

  1. Pollock A, Macfarlane A, Kirkwood G, et al.  No evidence that patient choice in the NHS saves lives.  Lancet. 2011;378(9809):2057-2060.  doi:10.1016/S0140-6736(11)61553-5
  2. Gaynor M, Moreno-Serra R, Propper C.  Death by market power: reform, competition, and patient outcomes in the National Health Service.  Am Econ J Econ Policy. 2013;5(4):134-166.  doi:10.1257/pol.5.4.134
  3. Kessler DP, McClellan MB.  Is hospital competition socially wasteful?  Q J Econ. 2000;115(2):577-615.  doi:10.1162/003355300554863
  4. Arrow KJ.  Uncertainty and the welfare economics of medical care.  Am Econ Rev. 1963;53(5):941-973. 
  5. Mikkers M, Padhraig R.  “Managed competition” for Ireland? The single versus multiple payer debate.  BMC Health Serv Res. 2014;14:442.  doi:10.1186/1472-6963-14-442
  6. 6      Mills A.  Health care systems in low- and middle-income countries.  N Engl J Med. 2014;370:552-557.  doi:10.1056/NEJMra1110897 
  7. Paris V, Devaux M, Wei L.  Health Systems Institutional Characteristics: A Survey Of 29 OECD Countries.  OECD Health Working Paper No. 50.  Paris: OECD Publishing; 2010.  doi:10.1787/5kmfxfq9qbnr-en
  8. Baggott R.  Evaluating health care reform: the case of the NHS internal market. Public Adm. 1997;75(2):283-306.  doi:10.1111/1467-9299.00061
  9. Cooper Z, Gibbons S, Jones S, McGuire A.  Does hospital competition save lives? Evidence from the English NHS patient choice reforms.  Econ J. 2011;121:F228-F260.  doi:10.1111/j.1468-0297.2011.02449.x
  10. Gaynor M, Moreno-Serra R, Propper C.  Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service.  NBER Working Paper No. 16164.  Cambridge, MA: National Bureau of Economic Research; 2010. 
  11. Bevan G, Skellern M.  Does competition between hospitals improve clinical quality? A review of evidence from two eras of competition in the English NHS.  BMJ. 2011;343:d6470.  doi:10.1136/bmj.d6470  
  12. Gaynor M, Town RJ.  Competition in Health Care Markets. In: Pauly MV, Mcguire TG,  Barro  PP, eds. Handbook of Health Economics. Vol 2. Elsevier; 2011:499-637.  doi:10.1016/B978-0-444-53592-4.00009-8  
  13. OECD Report.  Competition in Hospital Services.   http://www.oecd.org/daf/competition/50527122.pdf. Published 2012.
  14. Forsberg BC, Montagu D, Sundewall J.  Moving towards in-depth knowledge on the private health sector in low- and middle-income countries.  Health Policy Plan. 2011;26(1):i1-i3.  doi:10.1093/heapol/czr050   
  15. Hollingsworth B.  The measurement of efficiency and productivity of health care delivery.  Health Econ. 2008;17(10):1107-1128.  doi:10.1002/hec.1391 
  16. Herrera CA, Rada G, Kuhn-Barrientos L, Barrios X.  Does ownership matter? An overview of systematic reviews of the performance of private for-profit, private not-for-profit and public healthcare providers.  PLoS One. 2014;9(12):e93456.  doi:10.1371/journal.pone.0093456 
  17. Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D.  Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.  PLoS Med. 2012;9(6):e1001244.  doi:10.1371/journal.pmed.1001244  
  18. Broomberg J.  Managing the health care market in developing countries: prospects and problems.  Health Policy Plan. 1994;9(3):237-251.  doi: 10.1093/heapol/9.3.237  
  19. International Monetary Fund (IMF).  Macro-Fiscal Implications of Health Care Reform in Advanced and Emerging Economies.  Washington: International Monetary Fund; 2010.
  20. Le Grand J.  The Other Invisible Hand: Delivering Public Services through Choice and Competition.  Princeton, NJ: Princeton University Press; 2007.    
  21. Propper C.  Competition, incentives and the English NHS.  Health Econ. 2012;21(1):33-40.  doi:10.1002/hec.1804  
  22. Bloom N, Propper C, Seiler S, Van Reenen J.  the impact of competition on management quality: evidence from public hospitals.  Rev Econ Stud. 2015;82(2):457-489.  doi:10.1093/restud/rdu045 
  23. Office of Health Economics (OHE).  Competition in the NHS.  Report of the office of health economics commission.  London: Office of Health Economics; 2012.

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History

  • Received Date: 17 July 2015
  • Revised Date: 01 August 2015
  • Accepted Date: 30 July 2015
  • First Published Date: 01 September 2015

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