To bring market forces to bear on health care improvement, one needs service consumers who (a) Can detect quality (b) Are aware of what they are paying and (c) Have choices between providers. These three things are rarely true of the people who receive services from public sector addiction treatment programmes.
One way to handle this problem is to create an artificial market within a public health care system, i.e., have experts measure quality of care and then pay a bonus to treatment providers who offer the highest quality services. The Veterans Health Administration has done this for years, with impressive effects. But, in a paper kindly flagged by Austin Frakt today, my colleagues and I found that this approach has been less successful at improving the outcomes of addiction treatment.