Competition and Quality

I submitted the following comment to a blog dedicated to medical laboratory quality.  One of the posts argued that more competition would improve quality.  The blog can be found at:

http://www.medicallaboratoryquality.com

The argument that more competition would increase laboratory quality is, at best, weak.  Apple may have a more consumer friendly product, but is it of better quality? Blackberries work pretty well. More to the point, there are many examples in computers, cars, hedge funds and children’s toys, all competitive sectors, that have produced terrible quality: think pinto, Microsoft millennium 2000, dell batteries, firestone tires and cadmium.  Further to the point, health care is not like other consumer products and it is hard to argue sectors of health care that are not competitive, like hospitals or the NHS have poorer quality, though they certainly can be improved.  In the 1970’s when Ontario’s community laboratory sector was very competitive quality was poor, so much so that a series of conservative governments felt compelled to bring in regulations to improve quality and reduce competition.  Your example of Newfoundland pathology testing ignores the fact that similar problems have occurred in the United States with a competitive laboratory market and in Ontario, Manitoba and BC with multiple laboratory providers. The effect of more competition in the provinces with multiple laboratory providers has been increased secrecy, a barrier to improved quality, and decreased pre-analytic and post analytic quality.  Based on the evidence it is hard to sustain the argument that more competition will increase quality: the sounder argument
makes the opposite point.

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