for example a number of regions still reimburse providers on the basis of a feeperoutpatient polyclinic visit or pay by bed day in the hospital sector thereby encouraging overuse of the system and reducing incentives to enhance prevention figures and private insurers will act as purchasers of health care services for their insurees and competition among providers will be largely based on quality money will follow the patient and payment of providers will be fixed nationally leaving the regional funds the possibility of providing supplements under the new arrangements consumers will have free choice of insurer doctor or care institution eg polyclinic or hospital nonetheless tompson and smith argue that introducing and sustaining competition in health care markets is a particularly daunting task and existing experiments in oecd countries do not appear conclusive