Competition and quality in health care: the UK experience

The aims of this paper are threefold: first to review briefly the theoretical literature on competition and its predicted effects on health care quality; secondly to describe the attempts to introduce competition into the UK National Health Service (NHS); and third to review the outcomes of this experiment and ask how far the research findings are consistent with the next phase of reform that the new Labour Government proposed in late 1997.

A search was conducted using electronic data bases Unicorn, Medline and Health Planning and official monitoring statistics within the NHS. All references relating to district-based purchasing, general practitioner (GP) fundholding in its various forms and GP commissioning were reviewed.

Preference was given to prospective before and after studies with and without control groups, retrospective studies with and without controls, and case studies which were reinforced by similar supporting case studies.

The evidence suggests that there was little overall change for good or bad as a result of the reforms. The changes that did occur had an impact on speed of treatment, patient convenience and choice, but medical quality was largely unaffected. These benefits were reaped, in particular, by the more competitive agents - the family doctors or GPs.

Although not dramatic in outcome, these changes were significant because speed and convenience were the main deficiencies of the NHS in the eyes of UK consumers.