How economic policies which drive competition amongst hospitals impacts quality of care: The case of the English NHS (A systematic review)

Background: England's National Health Service (NHS) has undergone significant reforms, including the internal market in the 1990s and the 2006 patient choice reform. This systematic review examines how economic policies driving hospital competition impact the quality of care, particularly surgical outcomes, using access and effectiveness as indicators. Methods: This systematic review followed PRISMA guidelines. Studies were identified from four databases (Embase, Global Health, HMIC, and Medline) with inclusion criteria focusing on competition's effect on surgical care within the NHS. Results: From 308 studies screened, 12 met the inclusion criteria. Competition generally improves surgical quality, though variations exist across quality measures. Conclusion: Competition in the NHS has improved surgical outcomes, especially in high-volume procedures. These findings are relevant to US surgical practice, where similar competition may drive efficiency and quality. However, policies must address risks of patient selection biases and regional disparities to ensure equitable improvements across surgical specialities.