Competition in health care: its evolution over the past decade

Understanding the roller-coaster experience with the use of market forces in health care over the past ten years provides important context for discussions of likely future developments in the nature of competition. The period began with acceptance of managed care transforming the organization of medical care delivery and proceeded to a period in which many of the changes were reversed. The vision of integrated delivery has now been replaced with a vision of a more active role for consumers. But the greatest potential for a larger role for consumers lies in mechanisms that apply competitive pressure on providers to improve the quality of care that they provide and reduce their costs.