Vanderbilt Law Review

First Page



This Article is intended to put in context the many issues raised by this new interest in competition as a disciplinary force in the health services industry. After presenting a statement of the general theory supporting increased reliance on market forces, the Article turns to the key arguments advanced against that theory. The issues are many and complex, and the Article makes no attempt to treat them exhaustively. Rather, the aim is to highlight the weak as well as the strong points for and against competition in a manner that focuses the controversy and clarifies the issues. Until very recently, market advocates could responsibly discuss competition only in a general way, emphasizing its many substantial strengths in comparison to regulation's weaknesses. Now that the goal of reopening the policy debate has been achieved, however, market advocates have an increased responsibility to address the hard questions, which have previously been treated in footnotes or in theoretical pieces that escaped widespread attention. By the same token, the advocates of regulation now need to admit its problems and to approach the market in a more constructive way, seeking both a better understanding of how the market can function and solutions that do not too readily sacrifice the market's strengths. This Article, then, is concerned principally with establishing how competition can be used to obtain better performance from the health services industry. That is, at the moment, the key issue in health policy.