The competition may be a factor of efficiency and equality

The health care market is today essentially regulated by public, State or compulsory health insurance. This regulation, often centralized, is a factor of inefficiency and inequality. Economic inefficiency for example when we France of transplant centres in the rest of Europe, medical inefficiency sometimes, when the certification of the quality of care is struggling to find its place, or inequality when to offer in the whole abundant and easily accessible, only the better informed know precisely where to go and how to have the best chance.

The competition may be a factor of efficiency and equality. The consumer must be able to make choices, weigh its "price-quality" ratio, for ultimately mediate knowing. Five obstacles must be overcome to achieve: address the problem of the numerus clausus, allowing information on the price and the quality of care, implement a kind of "police" of the competition and let then the market will regulate.

The numerus clausus first. The competition, to practise, needs a context where the choice between several alternatives of consumption is possible. The competition is easier in the cities than in rural areas, to the professions without numerus clausus as to occupations which the "shortage" is organized. Difficult indeed to organize competition in orthodontics in Aurillac or ophthalmology at Dunkirk. If, in a given location, the offer is disaster, this lead to a surge in prices, which, in a normal competitive mechanism, will attract new operators that will lower their prices. But treat competition without processing of the numerus clausus seems dangerous and inequality factor.

Moreover, competition can only develop if the consumer can validly make play the "quality-price ratio." This is need to know the price. However access to this information is strictly limited in France. Section 80 of the Code of ethics of physicians (this article has its equivalent in the dentists or pharmacists) equates indeed information on the prices for advertising. The practitioner which broadcasts its rates is thus sanctioned by his order. The consumer is then condemned to discover the price of its consultation in the best room waiting and, at worst, when pay. Vectors as Internet much practical to disseminate such information, at least those practitioners wish to disseminate without risking sanctions so far.

After the price, on quality information. The consumer must also have elements on the quality of the proposed service. Some areas with dominant technology better suited to certification than others (radiology, dentistry...), but not field in health that can be improved through a process of certification. The motivation for a health professional to engage in this type of approach would be to be able to know its customers. But it is also prohibited by the Code of ethics that seeming to "advertising". Approaches to certification little penetrate this world of health. In the absence of another repository, the price might seem a criterion of quality to the consumer, as sometimes when you buy wine. The speech of the type "Yes, my dear, but it is because I do quality" maintains the confusion. If the competition to be progress in the quality factor, it also stimulate the production of quality repositories, by structures private as public, type "High authority of health".

To ensure compliance with the rules of competition, should be of course a kind of "police", effective, fast with no fear of medical issues or the powerful lobbyings. A professional refusing to display its rates or that systematically align them on the ceiling of the guarantee offered by the insurance, should be punished quickly and severely. Today, a complaint heard against the order of dentists of distortion of competition has still not been judged after four years. How, as of such time, to obtain respect for the basic rules of the competition

Finally, the main factor of success but also the most difficult to take politically and socially: let... the time! Changes by orders in Council, but not always effective, go fast and give the illusion of efficiency at the political level, while those arising from competition are durable but slower. It must be accepted that pulse made in a new set of actors have not immediate, linear effects in France. In this sense, competition would inherently be inequality at a given time factor: the market is not always equal and complementary organizations adapt progressively and this new order, unevenly finally exceeding the passive posture "behind the social security". The State, in this context, would be evaluator and impulserait changes without being the key player.