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Are Market Forces Strong Enough to Deliver Efficient Health Care Systems? Confidence is Waning

March/April 2004
Health Affairs, Vol. 23, No. 2
Len M. Nichols, Paul B. Ginsburg, Robert A. Berenson, Jon B. Christianson, Robert E. Hurley

This paper draws lessons for policymakers from twelve communities as we identify the power and limits of general market-based strategies for improving the efficiency of health systems. The vision of market forces driving our system toward efficiency attracted politicians, policy analysts, and practitioners in the 1990s. Today some policy advocates profess even more faith in unfettered market forces. Market participants in the twelve communities in the Community Tracking Study, however, have become doubtful, and our analysis confirms the logic of their pessimism. Major barriers to efficient market outcomes exist amid growing willingness to consider renewed government interventions.

Free access to this article is available at the Health Affairs Web site.


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The Center for Studying Health System Change Ceased operation on Dec. 31, 2013.