Published: 19/08/2004, Volume II4, No. 5919 Page 21

Your recent letters defending for-profit healthcare seem to have ignored the increasing body of international evidence in this area.

In fact, there is now very good evidence from systematic reviews that, compared with non-profit care, not only does for-profit care tend to cost more but also tends to deliver poorer health outcomes, such as higher mortality rates (Devereaux PJ, HeelsAnsdell D, Lacchetti C et al.

CMAJ 2004; 170:1817-1824 and Devereaux PJ, Choi PT, Lacchetti C, Weaver B, Schunemann HJ, Haines T et al. CMAJ 2002; 166:1399-406 and Duckett S.

Services Research and Policy 2001; 6:59-62).

Indeed, there is even evidence that promoting competition within a state-funded system such as the NHS also leads to higher mortality rates (Propper C, Burgess S, Green K. Journal of Public Economics; 88(7-8):12471272).

James Munro Director Health services research section School of Health and Related Research Sheffield University