Does More Choice Equal Better Care?

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<p>When Welsh health care economist Rhiannon Tudor Edwards spent a year in Seattle as a Commonwealth Fund Harkness Fellow, she was overwhelmed by the choices available to her: for coffee, TV channels, ice cream flavors--just about everything. But her brush with illness caused Edwards to question the value of choice in health care.<br><Br>In an <a href="/cnlib/pub/enews_clickthrough.htm?enews_item_id=19691&return_url=http%3A%2F%2Fwww%2Ecmwf%2Eorg%2Fpublications%2Fpublications%5Fshow%2Ehtm%3Fdoc%5Fid%3D324149%26%23doc324149">essay in the November/December issue</a> of <em>Health Affairs,</em> Edwards describes her experience navigating the U.S. health system after she developed a serious sinus infection. Not only does she report having trouble tracking down a provider who would agree to accept her "comprehensive" health insurance, she says she even found it difficult to schedule a timely appointment.<br><br>In the end, Edwards says, choice--among health plans, providers, and treatments--can only work well in a competitive market in which consumers are fully informed, goods or services are homogeneous, and there is free entry into and out of the market. None of these conditions, she argues, exist in the U.S. health care system today.<br><br>"[Choice] certainly is not a rational alternative to universal coverage or even wider basic health care coverage for all," Edwards concludes. "The market mechanism has not led to high-quality health care in the U.S., even for those with health insurance."</p>