The recent report of the Organisation for Economic Cooperation and Development (OECD) on Britain's health care reforms1 has been welcomed by the secretary of state for health as “the most authoritative assessment of the reforms produced so far.”2 The report is largely enthusiastic about the internal market reforms of the NHS. This is not surprising since the economists who wrote it are generally advocates of competition. There is, however, concern that the report and its conclusions appear to be based on inadequate evidence. The endorsement of the reforms by such a prominent body should therefore not induce complacency about the need for a better research base for health policy.

Health care reform has three main objectives: cost containment, equity, and efficiency (the relation between quality and cost). The OECD's report attributes the British health reforms to the belief of some policymakers “that an alternative system could be devised that retained the advantages of the NHS - universal coverage and cost control - while expanding consumer choice and reducing supply side inefficiencies.”1 It begins by comparing health spending and outcomes in Britain with …