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The case against choice and competition




Choice and competition are central planks of the English government’s health reforms and modernisation programme. Wales and Scotland have chosen a different path, which calls into question the suggestion that in an age of consumerism there is no other way to secure overdue changes in the provision and management of health care to improve their quality and responsiveness to user preferences. Yet pro-market enthusiasts pursue their agenda in the face of evidence that calls into question the claims they make. It is a curious position for a government that is wedded to evidence-based policy to find itself in. The policy puzzle is why, despite the contested nature of the alleged virtues of choice and competition, policy-makers persist with introducing a set of reforms which appear to threaten the very values and principles they profess to uphold. An alternative reform paradigm exists which acknowledges what makes public services public. This paper sets out the key features of what rediscovering public service entails adopting the notion of co-production as a means of bringing about a new relationship between professionals and the public that remains true to the National Health Service’s social purpose.

Suggested Citation

  • Hunter, David J., 2009. "The case against choice and competition," Health Economics, Policy and Law, Cambridge University Press, vol. 4(4), pages 489-501, October.
  • Handle: RePEc:cup:hecopl:v:4:y:2009:i:04:p:489-501_99

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    Cited by:

    1. Cooper, Zack & Gibbons, Stephen & Jones, Simon & McGuire, Alistair, 2010. "Does hospital competition improve efficiency? An analysis of the recent market-based reforms to the English NHS," LSE Research Online Documents on Economics 28578, London School of Economics and Political Science, LSE Library.
    2. OHE Commission, 2012. "Report of the Office of Health Economics Commission on Competition in the NHS," Monographs, Office of Health Economics, number 000168, January.
    3. Jones, Ian Rees & Higgs, Paul F., 2010. "The natural, the normal and the normative: Contested terrains in ageing and old age," Social Science & Medicine, Elsevier, vol. 71(8), pages 1513-1519, October.

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