After approximately 30 years, and following a decisive move towards integrated care systems, competition reforms in English healthcare seem to be rejected, even though the underlying relationship between the public healthcare system and private healthcare market remains. This paper explains how competition in English healthcare has developed to involve the Competition and Markets Authority and a sectoral regulator (NHS Improvement), and how general UK merger control and the prohibition on anticompetitive agreements have been applied. Current legislative proposals call for a substantial refocusing of competition authority involvement and removal of the regulator’s competition powers. These proposals are developing against a backdrop of closer cooperation between public and private healthcare providers in response to COVID-19. This paper concludes by suggesting that the current opportunity to rethink how competition works in English healthcare is a welcome development.

By Mary Guy1



Competition reforms in healthcare are often seen as a challenge, if not outright problematic, given the range of questions posed. Is competition intended as a means to an end, or an end in itself? Is the focus on competition on price, or quality, or both? Competition for or in the market? How much competition, and who decides this? What can be learned from other sectors, or other countries? Can competition only be antithetical to an overarching aim of delivering a he


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