Key points

  • In February 2019 the Competition and Markets Authority (CMA) published a working paper on the impact of hospital competition on rates of patient harm in the English NHS
  • We examine the central conclusion of the CMA paper – that the research provides ‘further empirical evidence that competition ultimately benefits patients’ – finding that this cannot be substantiated from the analysis
  • We outline how more rigorous well-designed research is needed to measure the impact of competition on the quality of care

Encouraging competition for clinical care as a means to improve performance in the NHS has been a major feature of policy over the past 30 years. The policy is contentious and hotly debated, yet might have benefits. Good empirical evidence on the impact of competition in the NHS is crucial to guide future policy, and for national bodies such as the Competition and Markets Authority (CMA) to regulate effectively. Informed and evidence-based coverage of findings reported in the press on the NHS’s competition strategy is also critical.

In February 2019 the CMA published a working paper on the impact of hospital competition on rates of patient harm in the English NHS entitled Does hospital competition reduce rates of patient harm in the English NHS?

In this paper we first look in more detail at the CMA working paper to examine whether the claim that it provides ‘further empirical evidence that competition ultimately benefits patients’ can be made with any confidence. We conclude it cannot.Secondly we outline how further investigation might be improved in future. We do this by examining the approach taken in the CMA working paper, which is an approach shared across many similar studies on this topic.

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