Why shouldn’t private companies run failing hospitals?

The idea of a company listed on the London Stock Exchange’s alternative investment market (AIM) taking over the running of a failing hospital would not have made national headlines in most other developed countries, but here the news has been met with anxiety and suspicion. After months of negotiation, Circle will run Hinchingbrooke Hospital in Huntingdon for 10 years in a deal worth £1bn and will assume the financial risks of making the hospital more efficient and paying off its £40m (€47m; $62m) debts (BMJ 2011;343:d7341, doi:10.1136/bmj.d7341). The building and staff remain in the NHS, but some worry that the deal could pave the way for “wholesale transfers” of hospitals to the private sector. This wouldn’t necessarily be a bad thing.

In fact, the United Kingdom is unusual in having nearly all its hospitals owned by the public sector. High performing systems such as those in Australia, Japan, and Switzerland have more of a mix of providers. In France nearly a third …