Why Must We Keep Discussing Strategic Purchasing and Managed Competition? Comment on "Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands"

TL;DR

This commentary discusses why strategic purchasing and managed competition in healthcare are still promoted despite evidence showing they don't work well.

Contribution

The paper critiques the logic and evidence behind strategic purchasing and managed competition in healthcare.

Findings

Strategic purchasing and managed competition do not effectively reallocate healthcare resources.

There is limited success evidence from the Netherlands and England.

The advocacy for these strategies persists despite weak logic and poor outcomes.

Abstract

Stadhouders and colleagues’ new measure answers an important question: Do strategic purchasing and managed competition redirect healthcare resources, and, if so, when, how, and to what? Applying it to the Netherlands, they find that they do not. This commentary first examines logical problems in arguments for strategic purchasing and managed competition, and then briefly reviews other evidence of their very limited success from, in particular, the Netherlands and England. It then raises the question of why strategic purchasing and managed competition continue to be advocated despite the poor logic of the arguments behind them and substantial evidence that they do not work.