Key points

  • Project led by the University of York, supported by the Health Foundation’s Policy Challenge Fund.
  • The final report focuses on the use of competition policies in health systems across five European countries (France, Germany, Norway, the Netherlands, Portugal), and how learning from these countries can be applied to the NHS.
  • Five country-specific case studies and an overview article were published in a special section of Health Policy on policies towards hospital and GP competition in five European countries.
  • Read the blog NHS competition policy and the EU that accompanies the final report.

How competition is used in the NHS to drive quality is a contentious issue – and one that needs navigating as the NHS in England moves to new ways of providing care. Competition is applied in a range of different ways internationally, which can provide useful insight for the NHS.

The University of York, supported by the Health Foundation’s Policy Challenge Fund, worked with leading academics in France, Germany, the Netherlands, Norway and Portugal to describe and analyse the use of competition in both primary and secondary care in those countries.

The project has assembled a wide range of knowledge on competition in the health sector with a focus on hospitals and GPs in these publicly-funded health systems. It has produced case studies on each country including in depth analysis of how competition works in practice, and the impact on patient choice. It also assesses whether policies were deemed successful and whether there were any unintended consequences. These case studies allowed the research team to identify the most effective approaches and determine the potential for translation of these to the NHS.

This work project will help policymakers in England understand how competition is applied in other health systems and so support decision making about the best use of competition in the NHS in the future. 

Contact details

For more information about this project, please contact ​​​​​Sally Al-Zaidy, Senior Policy Fellow at the Health Foundation or Professor Luigi Siciliani, University of York.

About this programme


Policy Challenge Fund


This programme offered £450,000 to six projects during 2016. The projects aimed to generate insight...

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