Why Must We Keep Discussing Strategic Purchasing and Managed Competition?; Comment on “Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands”

Articles in Press

Document Type : Commentary

Author

1 School of Public Health, University of Michigan-Ann Arbor, Ann Arbor, MI, USA

2 European Observatory on Health Systems and Policies, Brussels, Belgium

Abstract

Stadhouders and colleagues’ new measure answers an important question: Do strategic purchasing and managed competition redirect healthcare resources, and, if so, when, how, and to what? Applying it to the Netherlands, they find that they do not. This commentary first examines logical problems in arguments for strategic purchasing and managed competition, and then briefly reviews other evidence of their very limited success from, in particular, the Netherlands and England. It then raises the question of why strategic purchasing and managed competition continue to be advocated despite the poor logic of the arguments behind them and substantial evidence that they do not work.

Keywords

References

  1. Stadhouders NW, Koolman X, Tanke MAC, Maarse H, Jeurissen PPT. Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands. Int J Health Policy Manag. 2023;12:7506. doi:34172/ijhpm.2023.7506
  2. van Ginneken E. Governing competitive insurance market reform: case studies from the Netherlands and Switzerland. In: Greer SL, Wismar M, Figueras J, eds. Strengthening Health Systems Governance: Better Policies, Stronger Performance. Brussels: European Observatory on Health Systems and Policies, Open University Press; 2016:129-142.
  3. Jeurissen P, Maarse H. The Market Reform in Dutch Health Care: Results, Lessons and Prospects [Internet]. Copenhagen, Denmark: European Observatory on Health Systems and Policies; 2022. https://eurohealthobservatory.who.int/publications/i/the-market-reform-in-dutch-health-care-results-lessons-and-prospects.
  4. Siciliani L, Chalkley M, Gravelle H. Does Provider Competition Improve Health Care Quality and Efficiency? Brussels: European Observatory on Health Systems and Policies; 2022.
  5. Klein R. The New Politics of the NHS: From Creation to Reinvention. Oxford: Radcliffe Medical; 2006.
  6. Greer SL, Kulikoff R. The future of global health, without the United States. Bull At Sci. 2025;81(3):188-194. doi:1080/00963402.2025.2488675
  7. Enthoven AC. The history and principles of managed competition. Health Aff (Millwood). 1993;12 Suppl:24-48. doi:1377/hlthaff.12.suppl_1.24
  8. Marmor T. Fads in Medical Care Policy and Politics: The Rhetoric and Reality of Managerialism. London: The Nuffield Trust [Rock Carling Fellowship Lecture 2001]; 2001.
  9. Greer SL, Klasa K, E VANG. Power and purchasing: why strategic purchasing fails. Milbank Q. 2020;98(3):975-1020. doi:1111/1468-0009.12471
  10. Montás MC, Klasa K, van Ginneken E, Greer SL. Strategic purchasing and health systems resilience: lessons from COVID-19 in selected European countries. Health Policy. 2022;126(9):853-864. doi:1016/j.healthpol.2022.06.005
  11. Paton C. NHS Reform and Health Politics in the UK: Revolution, Counter-Revolution and COVID Crisis. Springer Nature; 2022.
  12. Powell M, Mannion R, Exworthy M. The NHS at 75: The State of UK Health Policy. Policy Press; 2023.
  13. Osipovič D, Allen P, Shepherd E, et al. Interrogating institutional change: actors' attitudes to competition and cooperation in commissioning health services in England. Public Adm. 2016;94(3):823-838. doi:1111/padm.12268
  14. Checkland K, Snow S, McDermott I, Harrison S, Coleman A. 'Animateurs' and animation: what makes a good commissioning manager? J Health Serv Res Policy. 2012;17(1):11-17. doi:1258/jhsrp.2011.011010
  15. Ban C. Ruling Ideas: How Global Neoliberalism Goes Local. Oxford University Press; 2016.
  16. Singh Y, Fuse Brown E, Papanicolas I. The rise of private equity in health care - not a uniquely American phenomenon. N Engl J Med. 2025;392(7):627-629. doi:1056/NEJMp2412002
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 14 July 2025

Files

History

  • Received Date: 29 May 2025
  • Revised Date: 11 July 2025
  • Accepted Date: 13 July 2025
  • First Published Date: 14 July 2025

Share

How to cite

Statistics