Competition in the UK National Health Service: mission impossible?

Despite the dominant ideology of the 1980s being libertarian, pragmatism triumphed and, despite several attempts to privatise the UK National Health Service, the Thatcherite reforms maintained public finance and sought to create competition in the supply of health care. Even this partial reform was radical and has led to major changes in structure and process. However, the Government has refused to evaluate both the cost and the outcome of the reforms. Furthermore, with minimal definition of how the 'internal market' was to work, the Government has regulated the competitive processes in an ad hoc manner, often responding to obvious but unforeseen problems (e.g. local monopoly power). Competition is costly to create, requiring large investments in managerial personnel and information technology, and difficult to sustain because of the propensity of capitalists, through self interest, to destroy capitalism. Problems such as quality, equity and the closure of excess capacity were well defined prior to the NHS reforms and have not yet been resolved following the reforms. Whether adversarial rather than collaborative relationships are more efficient in the health care sector is unknown. Indeed there remains little evidence to sustain the claims of political rhetoric that competition 'works' i.e. increases efficiency, enhances equity and contains costs. Despite this reformers seek to create competition and complete mission impossible.