Competition and containment in health care

In the United Kingdom and elsewhere, the preconditions for well-functioning internal markets (in relation to market structure, transaction costs, and information) may not exist in health care. Similar doubts exist about the i mpact of internal markets on cost-effectiveness. While the quantity of heal th care has increased, the effects on quality are ambiguous and costs have not been successfully restrained. With respect to equity of health care, fe ars have been raised that sections of the population may be discriminated a gainst. In the United Kingdom, resources have been shifted away from depriv ed areas and toward the more affluent. Health care services are once again being reformed, by New Labour in the United Kingdom and similar administrat ions elsewhere. The rhetoric of competition has given way to talk of partne rship. The imposition of new forms of rationing has been reshaped, not aban doned. Additional funding is required, along with an effective commitment t o the pursuit of equity and quality in health care.