title: Cost containment and the backdraft of competition policies.
abstract: This article offers an explanation of why governments and other purchasers found competition policies attractive, and it summarizes a set of new case studies. Faced with economic slowdown and the need to retrench social services, governments felt their legitimacy threatened and sought a new approach that would legitimize controlling costs. Starting in the 1980s, a group of pro-capitalist "moral entrepreneurs" launched an international business movement focused on reducing waste in governmental and welfare services through competition and privatization. Political leaders in a number of the developed industrialized countries enthusiastically embraced "managed competition" as a way to control the costs of health care services and to make them more accountable. The dangers of implementation and the extensive market failures that are ever-present in medicine, however, led most governments to pull back. Most nations that implemented competition policies experienced a political backdraft of protest from patients and providers that swept them out of office.
authors.affiliation: UMDNJ-SOM, Department of Psychiatry, Stratford, NJ 08084, USA. dlight@princeton.edu
authors.forename: D W
authors.initials: DW
authors.lastname: Light
mesh_terms: D003363:Cost Control / Q000331:legislation & jurisprudence*; D016520:Entrepreneurship; D005060:Europe; D006076:Government; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence*; D007843:Latin America; D018854:Managed Competition / Q000191:economics / Q000331:legislation & jurisprudence*; D019982:Organizational Case Studies; D011057:Politics; D011332:Privatization; D012941:Social Responsibility; D019366:Western World