Does making hospitals compete improve care?

Britain has twice tried to make NHS hospitals compete: the internal market of the 1990s, and the choice-and-competition reforms of the 2000s. Gwyn asked at the outset, with Walter Holland and Nicholas Mays in the Lancet, which patients the market would work for and at what cost, and whether the reforms would deliver a market or, in practice, emergent planning. Two decades on, with Matthew Skellern, he reviewed the evidence from both eras on whether competition between hospitals improved clinical quality, and whether choice was working for patients. With Ray Robinson he traced why the economic logic of markets and the political logic of a national service kept pulling English health policy back to the same path.