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Marketization of the NHS

Queens university hospital medical students practical exam

The issue

A search for efficiency savings and the desire to improve patient choice and satisfaction have been the drivers behind commercialised models of reform for the NHS in England.

Economic theory, however, has identified that markets in health are prone to failure, in ways that can often be detrimental to patient care.

Although there has been considerable research into the effectiveness of markets in the English NHS, the ethical and professional implications of a more commercially-oriented practice require further discussion.


Our policy

The BMA is committed to a publicly-funded and publicly-provided NHS that is funded by taxation and free at the point of care. Our concerns with the introduction of market models include, but are not limited to,

  • fragmented pathways and the potential destabilisation of local health economies
  • commercial profit prioritised over patient care
  • obligational conflict between shareholders' and patients’ best interests
  • a ‘two-tier’ health service that ignores less profitable areas of care
  • reduced obligation to participate in education and training, to the detriment of patient care and the medical workforce


Discussion paper

The ethical implications of the use of market-type mechanisms in the delivery of NHS care

In this discussion paper, we explore some of the potential ethical implications of market-oriented reforms specific to England, and invite readers to speculate about whether health goods and services can be traded without moral detriment.

Download the paper


Is the use of markets in the NHS immoral?

“Market mechanisms are on the supply side, not the demand. This is why the NHS is still a powerful symbol of social solidarity.”

Read the blog