Economic competition in health care: a moral assessment.

Economic competition threatens equity in the delivery of health care. This essay examines four of the various ways in which it does that: the reduction of charity care, increased patient cost-sharing, "cream-skimming" of healthy subscribers, and lack of information to patients about rationed care that is not prescribed. In all four cases, society must guard against distinct inequities and injustices, but also in all four, either the particular problem is not inherent in competition or, though inherent, it is not irremediable. Competition therefore cannot be finally morally accepted or rejected as an economic structure for delivering health care without knowing what among a wide range of supplementary things our society is actually going to do with it.