Independent Research and Policy Advocacy

Managed Competition – Revisiting Enthoven’s Principles

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The term “managed competition” was coined by Alain C. Enthoven in many of his early writings as a response to America’s ailing healthcare system. The idea evolved from its conception as a means of regulation to a much more active and “intelligent” management of the healthcare market by what he calls a “sponsor”. Scholars have identified the manifestation of managed competition in other jurisdictions, which adhere to some of Enthoven’s principles but might deviate from others, especially in the characterisation of the sponsor’s role. In this piece, we revisit Enthoven’s principles and propose a broader definition of the concept of managed competition in order that it may encompass other countries’ experiences that do not conform to a strict application of Enthoven’s concept. In the application of this concept in these health systems, there are certain limitations which have also been discussed in the paper.

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