Market model fails: linkages between health policy and performance outcomes in western industrial countries.
In recent years, political discourse has sung the merits of the market model as a panacea for escalating health expenditures. While selected market mechanisms may be useful to control spending, there are reasons to question full-scale use of this model to shape health policy. Using the experiences of seven western industrialized countries, the argument developed in this article is that the market model's own assumptions cannot be upheld because ethical, sociological, and political factors underlying health policy make its application impossible. Specifically, a competitive equilibrium does not exist; sale of health care goods and services do not conform to the rules of marketability; and non-increasing returns are not demonstrable. A discussion of health outcome performance and spending data points out the need to attend to equity distributional concerns, state commitment to the health care access, and the extent and breadth of input into health care decision-making as other factors that should be considered.
Duffy
D M
DM
Iowa State University, USA.
D019049:Developed Countries; D004465:Economic Competition; D017598:Efficiency, Organizational; D019981:Health Care Sector; D005102:Health Expenditures / Q000639:trends; D006291:Health Policy / Q000191:economics*; D006297:Health Services Accessibility; D018803:Models, Economic; D017063:Outcome Assessment, Health Care; D012935:Social Justice