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September 10, 2025Open Access

Managed Competition in Healthcare (?); Comment on "Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands"

Key Points

Competitive reform may not guarantee efficient allocation of funds in healthcare markets, highlighting potential risks.
The commentary emphasizes that existing research does not support a uniform theory on market forces regulating healthcare markets.
The authors argue that market-based healthcare reforms can be particularly risky in systems with limited state oversight and corruption.
Discussions on the capacity of market forces to properly govern healthcare remain contentious and varied in their conclusions.

Abstract

This article comments on the paper by Stadhouders, Koolman, Tanke, Maarse and Jeurissen titled Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands. Its main aim is to respond to the fact that the paper, without discussion, assumes that competitive reform stimulates the efficient allocation of funds. To achieve this goal, this article discusses existing knowledge related to the author’s assumption, highlighting that there is no uniform theory regarding the capacity of market forces to regulate healthcare markets. It also argues that market-based healthcare reforms may be very risky in countries with limited state regulatory capacity and widespread corruption.

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