Freeman Spogli Institute for International Studies Center for Health Policy/Center for Primary Care and Outcomes Research Stanford University


CHP/PCOR Publications


Image of Cover

Market-Based Reform: What to Regulate and by Whom

Journal Article

Authors
Alain C. Enthoven - Stanford University
Sara J. Singer - Stanford University

Published by
Health Affairs, Vol. 14 no. 1, page(s) 105-119
Spring, 1995


In today's competitive health care markets, market forces are motivating large innovations in cost reduction and customer service improvement. Government programs, on the other hand, are often associated with waste, complexity, rigidity, and coercion. Thus, there are important advantages to be gained by leaving resource allocation to the private market. But market forces in health care if left unchecked can produce undesirable results. Therefore, collective action at some level is often needed to correct these problems. In some cases, there is no alternative to government intervention; in others, with appropriate rules and incentives, collective action in the private sector may produce the desired results.

Market forces will not produce universal coverage, because some people cannot reasonably afford coverage, and others are motivated to take a free ride (by the cost of coverage, the availability of the safety net, and the easy access to coverage if there is guaranteed issue without exclusion of coverage for preexisting conditions or waiting periods), Thus, to produce universal coverage, the market needs to be supported by a system of incentives, subsidies, or possibly compulsion (mandates or taxes).