many health care systems share the swedish goal of empowering patients to exercise informed choice and there is evidence that geographical monopolies can stifle innovation and that competition in primary care drives quality an empirical analysis of the relationship between the quality of gp practices in england and the degree of competition they face shows that practices located close to other practices provide a higher quality of care than practices that lack competitors pike moreover recent research shows that patients are more likely to choose practices which earned more quality points under the quality and outcomes framework qof payforperformance scheme a necessary condition for greater competition to improve quality is that patients choice of practice is influenced by practice quality santos et al the competition and privatisation reforms can be designed to promote care continuity and coordination including through appropriate payment mechanisms and these principles should be embedded in the regulation of how these policies are implemented in practice strategies for progress towards these goals are discussed below