Intended for healthcare professionals

Rapid response to:


EU-US investor dispute rules could prevent reversal of decision to outsource NHS services, critics warn

BMJ 2015; 350 doi: (Published 20 January 2015) Cite this as: BMJ 2015;350:h373

Rapid Response:

The concerns on this side of the Atlantic may or may not reflect continuing protectionist thinking so common in healthcare. But if I think about the direction of travel in health system reform in the US, I would be a lot more worried about the EU's approach to healthcare which is to a great extent where the US through the Affordable Care Act (ACA) wants to go.

Certainly, the English NHS can shake the US tree through NICE, health technology assessment (although cost-comparative effectiveness is prohibited by the ACA), population purchasing and contractual commissioning which can disrupt incumbent providers (as much as protect substandard ones from financial failure). Many hospital chains (in the rest of the EU) might find the US easy picking as they bring their lean practices and different operating logic to the benefit of the ACA.

Perhaps more relevant, though, is that a sensible challenge regime is appropriate in all areas of policy making and implementation. When governments legislate in haste they act as authoritarians, and we've seen lots of that over security and in healthcare. A measure of accountability to the affected public (individuals and companies) should be welcomed, unless of course one is a disguised authoritarian.

Competing interests: No competing interests

23 January 2015
Michael Tremblay
health policy advisor
Cassis Limited
Brabourne Lees, Kent TN25 6RJ