BMJ  2007;335:1126-1129 (1 December), doi:10.1136/bmj.39400.549502.94

Analysis

Competition in a publicly funded healthcare system

Department of Medicine, Cambridge Hospital, Harvard Medical School, Cambridge, MA, USA

Are the UK and other countries right to adopt a market based model for improving their health services? Steffie Woolhandler and David Himmelstein believe that the appropriate response to the US experience with such policies is quarantine, not replication

The first 150 words of the full text of this article appear below.

Why would anyone choose to emulate the US healthcare system? Costs per capita are about twice the Organisation for Economic Cooperation and Development average. Forty seven million people are completely uninsured. Many others with insurance face high out of pocket costs that hinder care and bankrupt more than a million annually.¹ Mortality statistics lag behind those of most other wealthy countries, and even for the insured population, clinical outcomes and patient satisfaction are mediocre.^{2 3}

This dismal record arises, we contend, from health policies that emphasise market incentives. Even as the public share of health spending in the US has risen to 60% (box) investor owned firms have eclipsed the public, professional, and charitable bodies that previously managed the financing and delivery of care. The development and effect of US policies that mix public funding and private management has wider relevance because politicians in Europe and beyond are pushing analogous schemes.

. . . [Full text of this article]

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Rapid Responses:

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Praise for this article

Burritt S Lacy
bmj.com, 1 Dec 2007 [Full text]

Market based health care - the US experience

Douglas Seaton
bmj.com, 1 Dec 2007 [Full text]

Don’t let the buck stop here!

Mark Struthers
bmj.com, 3 Dec 2007 [Full text]

value for money is a key

L Sam Lewis
bmj.com, 1 Dec 2007 [Full text]

US failures tell us nothing about markets

stephen black
bmj.com, 3 Dec 2007 [Full text]

Some of us don't want markets or consumers

Neville W Goodman
bmj.com, 5 Dec 2007 [Full text]

'Look before you leap' - Policy mistakes are expensive and difficult to rectify!

Jane M Young
bmj.com, 6 Dec 2007 [Full text]

Quarantine is an excellent idea!

Alexander Spiers
bmj.com, 7 Dec 2007 [Full text]

Prevention is the only answer to the Health Care Crisis

Cleaves M. Bennett MD
bmj.com, 7 Dec 2007 [Full text]

Brilliant - now what? I know.....

Steven Ford
bmj.com, 8 Dec 2007 [Full text]

resistance to evidence

stephen black
bmj.com, 15 Jan 2008 [Full text]

Many countries succeeded competition in publicly funded healthcare

Janne Aaltonen
bmj.com, 30 Jan 2008 [Full text]

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