Unhealthy Competition

Markets are said to offer considerable advantages in reducing inefficiencies, in setting priorities, and in promoting innovation and responsiveness to user needs. Market forms of social coordination are therefore being promoted over the bureaucratic forms that have long predominated in health and other welfare services. It is also said that markets are superior to bureaucracy because they do not require external coordination: that they arise spontaneously from (and are more successful because of) the natural propensity of people to compete, bargain and trade. This article, however, demonstrates that market relations have to be created. It examines the adoption of market discourses and the creation of market-like relations in the provision of mental health care. It demonstrates that the anticipated gains from market-like relations are by no means assured. This is because the meaning of markets and the place of competitive or collaborative relationships is uncertain and ambiguous for health care management. The source of these ambiguities is both external and internal and the article offers evidence from each. The service delivery consequences of this situation suggest a greater strategic emphasis on establishing long-term relationships and minimising competition. However, government policy, the limited availability of alternative sources of finance and a discourse of competitive markets may mitigate against this

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• Quasi-welfare, associationalism and the social division of citizenship

  Rob Flynn•Citizenship Studies•1997

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