Unpacking the evidence on competition and outcomes in the NHS in England

In 2006 the NHS in England adopted a system in which patients were given choices between secondary care providers which were paid fixed prices (so called ‘payment by results’) for providing care. Gaynor et al have suggested that before 2006, hospitals did not compete and that competition after that date led to changes in travel patterns for patients in and around conurbations toward hospitals with both shorter waiting lists and higher clinical quality (according to one measure).1 Furthermore, those hospitals facing more competition (as they measured it) had better clinical quality after this reorganization, leading to the claim that competition saves lives2 and lowers lengths of stay, without any increase in total health expenditure.