Are health care ‘choice – and – competition’ reforms really efficiency driven?

Are choice and competition reforms only a route to improving economic efficiency or, do other goals buttress the so-called choice agenda? We here examine evidence of alternative explanations for drivers of choice reforms. More specifically, we explore whether there is evidence consistent with political incumbents’ aspirations to satisfy middle (median) classes (voters), alongside providers capture and service modernisation agendas as potential drivers. We concentrate on health care sector reforms given its central role as a reference universal welfare service - and focus on eight European countries where there has been heterogeneous experimentation with choice and competition reforms. Our findings suggest that whilst competition and choice reforms are primarily driven by the attainment of micro-efficiency and modernisation goals, middle class politics and to a some extent provider interests, appear to also prompt choice reforms. Hence, we conclude that allocative efficiency is not the sole driver of choice reforms.