PROFESSION, PRACTICE AND PROFITS - COMPETITION IN THE CORE OF HEALTH-CARE SYSTEM

The health care system constitutes the organizational framework in whi ch health care delivery takes place. The system and its reforms, there fore, have to reckon with the typical aspects of care delivery and med ical practice. This article deals with one specific kind of health car e reform which is becoming more and more popular in the Western world, namely the introduction of (managed) competiton. This diverse subject is restricted to the following question: does competition in health c are do justice to the normative aspects of medical practice and does i t result in economic efficiency? In short: profession, practice and pr ofits. Three lines of thought are developed and combined to answer thi s question. After an introduction on the health care system, competiti on is first considered from an economic point of view. Secondly, a nor mative approach of medical practice will be developed. Thirdly, the im plications of this view on medical practice for the health care system will be formulated. Finally, we readdress the competition issue focus ing on the physician-patient relationship. We conclude that a simultan eous realization of the normative aspects in this core relationship of health care can only be attained by competition at high transaction c osts. Competition, therefore,is likely to be inefficient. (C) 1997 Joh n Wiley & Sons, Ltd.