Nuffield Hospitals' David Mobbs argues that those who rail against the market stand to make health inequalities worse

Nuffield Hospitals' David Mobbs argues that those who rail against the market stand to make health inequalities worse

Market-driven efficiencies are the foundation of our economic success and the engine of innovation. But for many, there remains an instinctive caution about allowing market forces to apply to healthcare.

With Tory leader David Cameron avoiding the ideology of the market and health secretary Patricia Hewitt reluctant to embrace market terminology, there is real danger that the language of the old state-administered healthcare monopoly will obscure the benefits of what a healthcare market can provide.

The cautious political approach to market reform is driven by a widely held belief that market forces have always benefited the wealthy and that those who best understand the NHS system get more from it than the poor and disadvantaged.

If continued unchecked, this creeping fear will become a significant brake on the improvements to be gained from more diverse provision, competition, and consumer choice.

The 'inverse care law' - Welsh GP and campaigner Julian Tudor Hart's 30-year-old thesis that good medical care tends to vary inversely with the needs of the population served and especially where medical care is most exposed to market forces - still informs much of the debate and fuels fear of market reform.

This is despite almost 60 years of state monopoly in which deprived communities habitually receive less access to primary and secondary care than wealthier ones.

Patient power

What politicians are failing to grasp are the real improvements to the healthcare consumer that will be unlocked by a true healthcare market. Being able to speak the language of the market fluently would enable them all to communicate in ways that empower the patient and remove health inequality.

As the patient choice market for elective surgical care develops, the intensity of competition will increase. To capture or increase market share, providers ? whether NHS or independent ? will search for ever-more efficient approaches to meet the needs of their demanding healthcare customers.

Any good business text-book will show that 'market segmentation' is the most efficient way of identifying and meeting customer needs.

This can range from rudimentary forms of geographic and socio-demographic analysis to more sophisticated lifestyle profiling.

Market-thinking providers will be attracted to the opportunities afforded by unmet demand, ineffective competition and the low cost of customer acquisition. Any market segment in which there is a high incidence of a specific condition and low access to provision will become a prime target.

So it will be precisely the segments that the market wreckers tell us are most threatened by healthcare market reform that will benefit the most. Geographic areas of deprivation and socially disadvantaged populations represent significant opportunities to obtain customers at low cost.

So when Ms Hewitt reminds us all that the least well-off are nearly one-third more likely to need a hip replacement than the best-off, but are one fifth less likely to get it under the current state monopoly, she needs to have more faith in the language of the market.

It is the market that will invert the inverse care law ? because the incentive is to meet the needs of the consumer.

David Mobbs is chief executive officer of Nuffield Hospitals.