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The case against choice and competition

Published online by Cambridge University Press:  01 October 2009

DAVID J. HUNTER
DAVID J. HUNTER*
Affiliation:
Professor of Health Policy and Management, School of Medicine and Health, Wolfson Research Institute, Durham University, UK
*
*Correspondence to: Dr David Hunter, School of Medicine and Health, Durham University Queen’s Campus, Thornaby, Stockton on Tees TS17 6BH, UK. Email: d.j.hunter@durham.ac.uk
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Abstract:

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.

Type
Response
Information
Health Economics, Policy and Law , Volume 4 , Issue 4 , October 2009 , pp. 489 - 501
Copyright
Copyright © Cambridge University Press 2009

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