At The King's Fund, we are committed to learning from other countries. This commitment is strengthened by our new role as National Lead Institute for the United Kingdom, working with the European Observatory on Health Systems and Policies (a programme of the World Health Organization).
At a launch event for this work we invited speakers from across the country and overseas to debate the English health reforms. Our Dutch speaker, Jan-Kees Heldermann of Radboud University Nijmegen, was inundated with questions on managed competition and its role in the Dutch health system.
Both the Netherlands and the UK have high-performing health systems; they operate with commissioner-provider splits; they have sought to introduce competition into health systems to improve quality and efficiency. And with these similarities we might look to the Netherlands to see how competition is playing out.
However, the Dutch model doesn't provide a total blueprint for the NHS, and the distinctions between the systems of competition in the two countries are also significant. In the Netherlands competition is largely between health insurers rather than between providers, as it is in the NHS. Price competition has also been a notable feature of the Dutch system (and to date has produced mixed results). After some deliberation here in the UK, price competition is not set to feature in the NHS in the near future.
With these differences we cannot generalise and say what works there will work here too. There are, however, some important insights to be gained from the Netherlands. The role of the independent, sector-specific economic regulator in the Netherlands to support competition has created a stronger, more effective system of competition regulation than in other countries, including the UK. Getting Monitor's role right really will be key to the success of these NHS reforms.
Some evidence suggests that providers are confused as to what constitute 'anti-competitive practices' – or collaboration, which has discouraged them from working together. Ensuring that Monitor's role is to promote competition and collaboration will give providers the clarity needed to achieve integration in practice.
Part of the success of the introduction of competition in the Dutch system rests on its consistency in evolving its competition policy for more than 20 years. In contrast, the NHS has experienced several shifts in policy. Perhaps a more evolutionary rather than revolutionary approach is needed here to ensure the new system of economic regulation balances competition and collaboration effectively in the best interest of patients?
Find out more about our role with the European Observatory on Health Systems and Policies