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Objective: To analyse how competition is experienced and characterized by NHS and independent sector acute care providers in the English National Health Service (NHS). Methods: Semi-structured interviews with 49 senior staff in 15 NHS trusts and independent sector providers between November 2008 and April 2009, in England. Results: The market was predominantly defined based on geographical proximity. Competition was mainly on the periphery of catchment areas but markets were differentiated based on the scope and type of services. Niche providers, specialist hospitals and tertiary centres did not directly compete with district general hospital-type providers. Competitors were increasingly primary and community care providers, while there was little perceived threat from the private sector. There were many examples of how different providers (both NHS and independent sector) were co-operating and collaborating. Patients and general practitioners (GPs) appeared to be loyal to local providers. Conclusion: The providers' view of the market and the relevance of historical relationships and loyalties suggest fine grained variations in competition which is consistent with a relational rather than structural approach to competition. Also the evidence on embeddedness of relationships implies that collaboration might be a strong lever for quality improvement locally. Finally, some of the agreements found might be deemed in breach of the rules of competition but they may well be in the interests of patients and taxpayers, with implications for regulation in publicly funded health care systems. [ABSTRACT FROM AUTHOR]

The author discusses some of the ways to develop resilience in the medical community. These include building strong social networks, fostering psychological resilience in order to better deal with the emotional drain of medical practice, reframing setbacks in the positive way, and understanding and maximizing the use of one's strengths.

Background: High profile failures of care in the NHS have raised concerns about regulatory systems for health-care professionals and organizations. In response, the Care Quality Commission (CQC), the regulator of health and social care in England overhauled its regulatory regime. It moved to inspections which made much greater use of expert knowledge, data and views from a range of stakeholders, including service users., Objective: We explore the role of service users and citizens in health and social care regulation, including how CQC involved people in inspecting and rating health and social care providers., Design: We analyse CQC reports and documents, and 61 interviews with CQC staff and representatives of groups of service users and citizens and voluntary sector organizations to explore the place of service user voice in regulatory processes., Results: Care Quality Commission invited comments and facilitated the sharing of existing service user experiences and engaged with representatives of groups of service users and voluntary sector organizations. CQC involved service users in their inspections as "experts by experience." Information from service users informed both the inspection regime and individual inspections, but CQC was less focused on giving feedback to service users who contributed to these activities., Discussion and Conclusions: Service users can make an important contribution to regulation by sharing their experiences and having their voices heard, but their involvement was somewhat transactional, and largely on terms set by CQC. There may be scope for CQC to build more enduring relationships with service user groups and to engage them more effectively in the regulatory regime., (© 2018 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

As the health service's financial challenge deepens, Ruth Robertson looks at the six types of rationing identified by Klein and Maybin and asks to what extent they apply today.

The share of U.S. workers in small firms who were offered, eligible for, and covered by health insurance through their jobs has declined over the past decade. Less than half of workers in companies with fewer than 50 employees were both offered and eligible for health insurance through their jobs in 2010, down from 58 percent in 2003. In contrast, about 90 percent of workers in companies with 100 or more employees were offered and eligible for their employer's health plans in both 2003 and 2010. Workers in the smallest firms--and those with the lowest wages--continue to be less likely to get coverage from their employers and more likely to be uninsured than workers in larger firms or with higher wages. The Affordable Care Act includes new subsidies that will lower the cost of health insurance for small businesses and workers who must purchase coverage on their own.

An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States--both with and without health insurance--are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.