Competitive healthcare and the elderly: handle with care.

88 An unprecedented wave of major, market-based reforms is weeping through health systems across high-income economies. n Greece and Portugal, the reforms which feature cost-cutting and ost-shifting measures as well as structural changes, are knock-on ffects of austerity measures put in place resulting from the global nancial crisis of 2007–2008, and the subsequent 2008–2012 global ecession. In comparison, similar health reforms in the United tates and England were already an agenda prior to the economic lump and were finalized and reinforced in the midst of the global ecession. While the impetus for the reforms and their features re different, the end is the same: introducing more competition n healthcare markets and opening the doors of traditional public ealth systems to the private sector. As an immediate consequence, roviders, purchasers (i.e. local commissioners and insurance comanies) and consumers of healthcare have been subject to new ompetitive pressures as well as new conditions that support ompetitive behaviors. Competitive healthcare, it is hoped – and romised by policy makers, will lead toward achieving affordabilty, acceptability and availability in healthcare, after all competition as worked wonders elsewhere. Increased competition in air travel, with the proliferation of ow-cost carriers, for example, has dramatically reduced the cost of ying, accelerated the automation of services and changed travel taple or airline standard (such as the availability of complimentary n-flight treats and checked baggage, unfortunately). The evidence n competitive healthcare, covering competition on the supplyide both in terms of delivery of care and insurance as well as emand side, however, is mixed [1]. Whereas the findings indicate hat competition leads to a reduction in prices, as economic thery suggests, the change in quality in terms of clinical outcomes s less clear. At the same time, analysis of the efforts aimed at ndividuals to act more sovereign in their utilization of healthcare i.e. choice care provider or health plan) have delivered ambiguus conclusions. Given the evidence on competitive healthcare – ndeed, the nature of the markets for healthcare, as second best whereby interventions aimed at addressing market failures actully lead to a decrease rather than an increase in economic efficiency s intended), a cautious approach to increased competition is warrnted. Just as the side-effects of medication should be paid attention, he unintended consequences of competitive healthcare should be