the seminal contribution by arrow underlined how the pervasive market failures in health care markets lead unfettered competitive forces to lower rather than raise welfare nonetheless several oecd countries have recently strengthened competition by introducing regulated choice mostly among providers and to a lesser extent among insurers these reforms are based on the presumption that competition coupled with a good regulatory setting will improve health care service quality while limiting the adverse effects of unfettered market forces most notably cream skimming selective coverage and unequal access to services recent evidence mostly covering the united kingdom and the united states shows that competition among hospitals if accompanied by strong and effective regulation can lower expenditure andor enhances quality of care gaynor etal an early evaluation of the reforms initiated in sweden in with the goal of increasing choice of primary care doctors indicate that they have improved access to health care anel et al for a panel of oecd countries de la maisonneuve et al