Is competition bad for our health(care)? We simply don't know

Abstract

In The Lancet Oncology, Ajay Aggarwal and colleagues1 apply innovative analytics to study the movement patterns of almost 20 000 patients accessing prostate cancer surgery across the National Health Service (NHS) in England between 2010 and 2014. They find that, in the presence of pressures to centralise surgical services and intense competition, and in the absence of any publicly accessible measure of service quality to allow comparisons, those providers who invest in high tech, in this case robotic, surgery equipment, fare better than those who don't in attracting patients and growing their business. In fact, those who don't, risk closure. One in four of the country's 65 radical prostatectomy centres closed between 2010 and 2017, with a trebling of the number of robotic centres over the same period. None of the 16 NHS centres that closed had invested in robotic equipment. Nor had any of the centres that closed done so because of explicit evidence of poorer quality. Moreover, in a previous analysis of referral patterns for specialised prostate cancer surgery,2 the same authors showed that patients who travel longer distances, bypassing their local centres, tend to be younger, less ill, and of higher socioeconomic background than those who do not.