NHS competition saves lives

More evidence:

The lives of 300 heart attack patients have been saved every year since competition was introduced to NHS hospitals, according to a new study.

In more detail:

The updated paper, published in The Economic Journal, looks at the effects of a more liberal NHS on 30-day mortality rates for patients diagnosed with Acute Myocardial Infarction; that is the proportion who died within a month of suffering a heart attack.

In 2006, Labour gave patients the right to choose where to be treated for routine surgery, introduced a fixed price for many procedures carried out in hospitals, and allowed those that balanced their books the right to become more independent Foundation Trusts.

Dr Cooper and colleagues looked at data for 433,325 patients who had heart attacks between 2002 and 2008 – covering the period before and after fixed-price competition was introduced – at 227 hospital sites in England.

They found that death rates dropped by about 7 per cent under the new regime, and fell quicker in “more competitive markets”. The number of patients being treated also fell.

As a result, the authors estimate that “the reforms resulted in approximately 300 fewer deaths per year after the reforms were introduced in 2006”.

This is the second paper (that I know about of course) that shows that competition in health care saves lives. Anyone care to point me at those papers that show that competition kills people?

18 thoughts on “NHS competition saves lives”

  1. JustAnotherTaxpayer

    “competition kills people”

    That is what the Guardian tells me every day, Tim, surely it is true?

  2. The evidence is compelling, but the more likely trade off to look for isn’t evidence that competition kills, but that competition introduces more inefficencies than a state monopoly.

  3. “but that competition introduces more inefficencies than a state monopoly”

    you haven’t had very much to do with state monopolies have you?

  4. Emil I’ve seen enough public sector from the inside to realise it is highly unlikely, but it is the more likely trade off to investigate rather than the ‘competition kills people’ trade off which is something of a strawman.

  5. Gary,

    but we are not talking about whether competition kills but if it saves more lifes. If it saves more lifes with the same money it is almost by definition more efficient.

  6. Well yes, I can indeed point to a report which shows that competition in the provision of healthcare can “kill people”. It’s the very one you mention, which states very clearly that “research for the UK…shows that when competition was introduced in the early 1990s in a regime which allowed hospitals to negotiate prices as well as quality there was a fall in clinical quality in the more competitive areas.”

    The conclusion of this study and indeed all the other publically available research that I’ve come across is both unanimous and unequivocal: that competition in health services under a fixed price regime seems to have a beneficial effect on outcomes, but competition under a regime which allows providers to compete in terms of both quality and price has the opposite effect and does indeed “kill people”.

  7. Ho hum, got the bit between our gnashers with this one, I see.

    OK. Not even read the link but would be very interested to know the respective income and education levels of those whose lives were ‘saved ‘by competition. They would be the ones most likely to also make necessary lifetsyle changes and follow doctors’ orders.

    Also, disgusting to see the balancing of books being applied to healthcare, with clinician bing turned into accountants. And while stopping 300 people a year dying from heart disease is a good thing, it’s very possibly a drop in the bloody ocean and no real proof the benefits of competition.

  8. Hey Martin – I’m with you Comrade! I would be f’ing disgusted to hear that this was all a scam just to save the Bourgeois. Why the bloody hell would we want to go saving those class traitors? eh?!

    Saving lives? I say pah – don’t these people realise there are more important things at stake here?

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  10. Gary

    “Hey Martin – I’m with you Comrade!”

    I don’t get your point. Please explain, if you can.

  11. Martin @12,
    My point more soberly made was:
    1)The income and education levels of those saved is not important. That they *were* saved is important. ´Compliance´ with post-surgery instructions (take drugs on time and to completion, exercise, etc) and hence patient outcomes is always associated with higher education/wealth. It may well be that choice is exercised mostly by the well educated/rich, and they benefit disproportionately (I suspect they do), but that in no way invalidates the findings, the conclusion, the implications or the point made in the main post.

    2) You may be ´disgusted´ with the idea that Doctors have to concern themselves with such grubby issues as money (although they were mighty keen to stoop to such low levels when negotiating the new pay deal with New Labour), but you miss the fact that the form of competition proposed and imposed is ´non price based´i.e. doctors and patients must always and forever choose on quality alone, and never on price. In that way our precious doctors are structurally unable to be lowered into matters such as money and balancing the books.

    3) 300 saved may be a ´drop in the ocean´to you, but 300 of my family, friends, neighbours and collegues would not be a drop in the ocean for me. I suspect you would feel the same if you were to reexpress your point in the active voice.

    Taken together, your combination of failure to read the report, jumping to conclusion regarding the role of price and your concern with the social strata of those who may benefit reminded me greatly of the ´Trotsky Trolls´who frequent this blog. That was my point.

  12. Gary,

    “1)The income and education levels of those saved is not important. That they *were* saved is important.”

    Agreed. Indeed, I didn’t say anything to the contrary, which makes the thought you seem to have that I did all the more repellent.

    “Compliance´ with post-surgery instructions (take drugs on time and to completion, exercise, etc) and hence patient outcomes is always associated with higher education/wealth. It may well be that choice is exercised mostly by the well educated/rich, and they benefit disproportionately (I suspect they do), but that in no way invalidates the findings, the conclusion, the implications or the point made in the main post.”

    No, it invalidates all four, as the introduction of ‘choice’ – a choice, incidentally, exercised at the expense of others – would lead to the rich receiving better treatment than the poor on the public purse. This is not what the NHS is for, and as we know the NHS is loathed by a large sections of the population who wish to pay tax and who feel themselves beholden to nothing and nobody. The outcome I have related might be the desired consequence of the mechanism suggested in what is an economic and not medical journal, but would most certainly be the actual one.

    “2) You may be ´disgusted´ with the idea that Doctors have to concern themselves with such grubby issues as money (although they were mighty keen to stoop to such low levels when negotiating the new pay deal with New Labour), but you miss the fact that the form of competition proposed and imposed is ´non price based´i.e. doctors and patients must always and forever choose on quality alone, and never on price. In that way our precious doctors are structurally unable to be lowered into matters such as money and balancing the books.”

    And in a system which is entirely funded by the public and which is intended to be free at the poitn of use to everyone, the only way this can be effected is by devoting more resources to some areas than others. The rich cardiacs would get a top class unit, paid for by sacking the midwives. Primitive and brutal, but that seem to be the way the system works. As I said on the post that Tim wrote after his father required emergency heart surgery, as currently organised the NHS is very good at dealing with emergency cases, such as heart attacks or neonatal intensive care medicine. Resources are spent in one area deemed to be urgent which means that resources are not spent elsewhere, which is why it can take over six months for me to get a neurologist’s appointment on the NHS in respect of my incurable, untreatable brain illness, while the same NHS was able to get a professor of cardiology out of his bed at 04.00 to operate on my mother after she suffered a massive heart attack on his ward, and a surgeon out of his bed at 05.00 to deliver my eight-week premature son at the start of his longish stay in hospital in really quite difficult medical circumstances. If I have to wait so that cases like that can be treated, I’ll wait. But a lot of people in the UK don’t like waiting their turn in line anymore, when they should be grateful that their fellow citizens are prepared to fund their treatment on any terms. That they are unsociable and lack of civic spirit does not mean that the system should be re-calibrated for their convenience when there will certainly be other and probably very much more urgent demands on the resources of the NHS.

    “300 saved may be a ´drop in the ocean´to you, but 300 of my family, friends, neighbours and collegues would not be a drop in the ocean for me. I suspect you would feel the same if you were to reexpress your point in the active voice.”

    Get off your high horse, Comrade. See above.

    “Taken together, your combination of failure to read the report, jumping to conclusion regarding the role of price and your concern with the social strata of those who may benefit reminded me greatly of the ´Trotsky Trolls´who frequent this blog”

    I think you really mean ‘the combination of your failure to, etc. And BTW, you claim no concern for social strata in these findings, but suspect that the well-educated and rich might be the beneficiaries of these processes. Sounds like doublethink to me.

  13. Martin,

    I suspected you were concerned abou the social strata of those who would benefit. You deny it, but go on to say “[competition] would lead to the rich receiving better treatment than the poor on the public purse.”

    My suspision that you are concerned about the well educated/rich benefitting from this iniative is now deepened.

    My point remains that they may well benefit, that benefit may even be dispporortionate, but given that is a benefit with no incremental cost (1) we are logic-bound to accept it. You assert that “the only way this can be effected is by devoting more resources to some areas than others”, but that is factually incorrect. You are speaking of your feelings and presumptions, not what is happening on the ground. You are in fact wrong on this one. that is what non price competition means. It means no extra costs, only extra quality is allowed.

    You are a Trotsky Troll. I win! (2)

    1) If you still think these improvements drive extra cost in the NHS, then you have still not investigated this in any depth whatsoever and you shouldn’t really bother replying.
    2) That arguement seems to work a treat on CiF, so why not here?!

  14. “My suspision (sic) that you are concerned (surprised you didn’t make that one ‘conserned)about the well educated/rich benefitting (sic)from this iniative (sic)is now deepened’ –

    Well, at least you got the verb right. Never ceases to amaze me how some libertarians’ IQs contract in inverse proportion to the violence of their rhetoric. For example, do you think that shouting ‘Trotsky Troll!’ at someone who can’t help blowing raspberries at passers-by is going to alter how they think in any way at all? No, of course it’s not. You should take a leaf from Tim’s book. Tim never loses his cool. I might be be back tomorrow, If not, you can rest assured that nothing, absolutely nothing, you have said has made the slightest impact on me. Got to go, as I have a nakedly commercial book to write and a perfect window of opportunity in which to start on it. It’s been fun – for me at least.

  15. Martin you are correct. My spelling was poor, and with that my argument is refuted. I now see the light: competition *is* a wheeze to benefit the wealthy. That is *not* what the NHS is for, and we should just be bloody grateful for what we are getting.

    Your views are Righteous, and I see now why you have no need to delve into such petty matters as the evidence and what competition actually means in this instance.

    Humbly yours,
    A coward

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