More on the impact of choice and competition on the NHS

Back in January I blogged about research coming out of Bristol University:

They conclude that competition resulted in better services: “The research finds that hospitals located in areas where patients have had more choice since the NHS reforms have had higher clinical quality (as measured by lower death rates following admissions) and shorter lengths of stay than hospitals in less competitive areas. What’s more, the hospitals in competitive markets increased their quality without increasing total operating costs or shedding staff, suggesting that the policy of choice and competition in healthcare can have benefits.”

The crucial ‘but’ is that in these cases prices were fixed – so it was competition based on quality, not price. In fact, price competition makes things worse.

Carol Popper, of Bristol University and Imperial College London Business School, has now returned to the theme as Solution Focused Politics reports:

There is no evidence from recent studies of the UK that allowing patients more choice and exposing poorly performing hospitals to the threat of their patients choosing another provider is going to lead to the whole-scale destruction of the NHS and large equity issues. On the contrary, the evidence we have suggests that it has the power to improve outcomes for patients.

2 responses to “More on the impact of choice and competition on the NHS”

  1. This is an area where real care is needed. Carol's point is absolutely fair – the evidence available indicates that under certain conditions competition doesn't negatively impact (and may positively impact) on quality (as long as we make assumptions that what is being measured is an adequate indicator of service quality). But this conclusion needs to be set in the broader context of what we don't know. Carol has written elsewhere in the academic literature recently about just how much we don't yet know about competition in health care markets. There is a major risk of incautious generalisation. I blogged about this recently if you're interested:

    http://www.alexsarchives.org/?p=3204 (Appraising health reform).

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