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Wednesday, 29 January, 2003, 15:43 GMT
NHS competition 'costs lives'
The study looked at deaths among heart patients
Introducing more competition into the NHS could lead to higher death rates among patients, a study suggests.

Researchers at Bristol University say forcing hospitals to compete against each other puts patients at risk.

They suggested that some hospitals are more concerned with saving money and cutting waiting lists than the quality of care they provide.

It is not necessarily a convincing argument against competition

John Appleby,
Kings Fund
However, the Department of Health and other experts have rejected the findings.

Professor Carol Propper and colleagues at the university's Centre for Market and Public Organisation examined the levels of competition and quality of care in all acute hospitals in England in the 1990s.

Internal market

This covers the period after the introduction of the NHS internal market, which aimed to keep healthcare costs low by forcing hospitals to compete for patients.

The rate of deaths from emergency admissions for heart attacks was used to determine quality of care. This measure is widely used in the United States.

They compared death rates in those hospitals with no local competition - one in three trusts - with those that had to compete for business.

They found the death rates among these patients were much the same in the early 1990s.

However, they discovered death rates started to vary once competition took hold in the health service.

According to their study, death rates were highest in those areas that had to compete for business.

While Labour scrapped the internal market when it came to power in 1997, its proposals to create foundation trusts will lead to hospitals once again competing for business.

In addition, the purchaser-provider split between primary care organisations and hospitals still exists.

Writing in the CMPO bulletin, Professor Propper said the problem may have been exacerbated by the fact that while hospitals had access to financial data they had little information on the quality of care they provided.

"Both purchasers and providers of health care in the internal market cared a lot about costs.

"Data on prices were much more readily available than data on quality," she said.

Quality of healthcare

The government has since introduced performance tables, which rate hospitals on the quality of care they provide.

This research doesn't apply to the NHS

Department of Health spokesman
Professor Propper said urged ministers to ensure hospitals compete on quality of care rather than finances.

"Measures of quality need to be widely available in order for competition to improve the quality of healthcare.

"The current government has put considerable effort into making such data available: It is hoped that this means that the purchasers of healthcare will be able to use these successfully to ensure quality does not fall where competition is strong."

But John Appleby of the independent think tank The Kings Fund said more research is needed.

He criticised the study for failing to compare death rates in the 1990s with death rates in previous decades when competition between trusts did not exist.

He suggested measuring death rates among patients admitted to hospital with heart attacks was crude.

"It is not necessarily a convincing argument against competition," he said.

The Department of Health also rejected the study findings.

A spokesman said: "This research doesn't apply to the NHS. The internal market has been abolished, and we have introduced national standards and inspections. Nor does it reflect how the NHS will be in future with the government's reforms.

"NHS Foundation hospitals will not compete on price. The individual choices of patients will become the driver of the health care system in our country."

Liberal Democrat health spokesman Dr Evan Harris said: "It is important to note that this is only one study, which may be flawed. It is not necessarily proof that competition causes poorer healthcare.

"But the study is a timely reminder that the information used to judge hospitals┐ performance is very flawed."

See also:

15 Nov 01 | Politics
21 Jan 03 | Health
14 Nov 02 | Health
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