COMPETITION AND QUALITY IN HEALTH-CARE - THE UK EXPERIENCE

Objectives. The aims of this paper are threefold: first to review brie fly the theoretical literature on competition and its predicted effect s on health care quality; secondly to describe the attempts to introdu ce competition into the UK National Health Service (NHS); and third to review the outcomes of this experiment and ask how far the research f indings are consistent with the next phase of reform that the new :Lab our Government proposed in late 1997. Data sources. A search was condu cted using electronic data bases Unicorn, Medline and Health Planning and official monitoring statistics within the NHS. All references rela ting to district-based purchasing, general practitioner (GP) fundholdi ng in its various forms and GP commissioning were reviewed. Study sele ction. Preference was given to prospective before and after studies wi th and without control groups, retrospective studies with and without controls, and case studies which were reinforced by similar supporting case studies.Results of data synthesis. The evidence suggests that th ere was little overall change for good or bad as a result of the refor ms. The changes that did occur had an impact on speed of treatment, pa tient convenience and choice, but medical quality was largely unaffect ed. These benefits were reaped, in particular, by the more competitive agents - the family doctors or GPs. Conclusion. Although not dramatic in outcome, these changes were significant because speed and convenie nce were the main deficiencies of the NHS in the eyes of UK consumers.