Competition in Primary Healthcare in Ireland:More and Better Services for Less Money

Understanding precisely the nature of competition in primary healthcare has an important role to play in understanding how to improve the delivery of healthcare services. This is particularly the case in Ireland, where the private sector plays such a large role in primary care. If we do not understand competition, well-intentioned regulations and policies are less likely to be effective and more likely to result in excessive costs and under-utilisation of primary healthcare. This in turn can increase Ireland’s overall health expenditure and contribute to a higher cost of living in Ireland and thus lower competitiveness. This paper shows how well-designed regulations and systems for State funding of primary healthcare can ensure that competition works well and contributes to the better availability and quality of services at the lowest possible cost. The most common barriers to entry and expansion in primary healthcare markets are outlined and pricesetting mechanisms examined. Examples are used to illustrate the benefits to consumers and the State where these obstacles to competition have been removed, and the difficulties where they remain. Conclusions are drawn on the implications of this analysis for the governance of regulatory bodies, for regulatory Codes of Conduct, and for achieving value for money. It is time for the culture of the healthcare professions to move towards one where it is no longer considered “unprofessional” to provide a competitive service.