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Will a market deliver quality and efficiency in health care better than central planning ever could? Yes

BMJ 2010; 340 doi: (Published 10 March 2010) Cite this as: BMJ 2010;340:c1297
  1. James Gubb, director
  1. 1Civitas Health Unit, London SW1P 2EZ
  1. james.gubb{at}

    James Gubb and Stephen Smith (doi:10.1136/bmj.c1299) are convinced that market forces will improve the NHS, but Neal Lawson (doi:10.1136/bmj.c1300) and Jonathon Tomlinson (doi:10.1136/bmj.c1302) have their doubts

    Between 1997 and 2007, NHS productivity fell by 4.3%. In the same period, average productivity across private sector industries increased by 23%.1 The driver of that increase can be summed up in one word: competition.2 To take a specific example, regulatory reforms that introduced competition into UK electricity, gas, and water industries resulted in productivity growing by over 10% a year during the 1990s.3 Although health care is inherently more social, similar progress is possible.

    When prices are controlled studies have found a significant and positive relation between market concentration (a proxy for the level of competition) and higher quality on indicators such …

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