Key points

  • Competition improved clinical outcomes in England but not necessarily in the USA.
  • In the USA, competition was more likely to be associated with reduced costs for patients, providers and commissioners.
  • Less positive outcomes included potential fragmentation, reduced access and resistance from staff and patients.

A great deal has been written about the pros and cons of competition in health care, but much of the literature is based on theories or opinions, rather than empirical research.

This evidence scan summarises empirical research about improving quality using a competitive market, the system features needed for competition to work most effectively and any unintended or negative consequences.

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