How can this question on markets in healthcare be improved?

Question

I sometimes ask or try to rescue questions that are marginal given the rules here but when they get downvoted or closed for good reason I just accept the result. But I recently asked one that doesn't seem problematic by any of the normal standards.

The question is here: Is there evidence that competition between hospitals creates better quality and lower cost healthcare?

It has attracted a lot of critical comment arguing that it is off topic or unanswerable and it has several close votes. I'm struggling to see why. I don't mind people not liking the question and downvoting it, but voting to close it seems a little much.

It may be that I am simply too close to the subject matter and not objective. So I would like to ask for some help from those who are not engaged on this topic. Is the question unclear, too vague, to be a good question? Is it asking for opinion not evidence? Should we close questions because some people think they are too hard to answer?

If the question could be usefully reworded to avoid the criticisms, please suggest some ideas. I think it is asking a focussed question on a topic where evidence is potentially available. It looks to me like a well formed question on a significant topic. Am I wrong?

Answer 1

I haven't voted this question up or down, or commented upon it. I can't see any good reason for a mod to get involved.

However, the question seems largely unanswerable to me.

This is probably a strained analogy, but this is what it reminds me of:

Imagine a hospital is considering upgrading its billing system software. The powers-that-be recommend a new system that gets roundly criticised by the medical profession and patients as being not as good as the old system.

One developer comes to StackExchange and says "This proposed billing system software migration is a move from Windows to Linux. Can Linux be used to create better quality and lower cost software?"

The answer is... err, yes it can, in some circumstances. Sometimes not. But most importantly, it isn't the only factor in deciding between the two systems, and it isn't even the most important factor people are considering when they make the decision.

Framing the discussion as Linux versus Windows rather than System A versus System B is distorting the discussion. Whether it is fair or not, it comes across as political point-scoring rather than fair evaluation of the best of the two proposals being considered.

Maybe you can come up with evidence that most migrations (worldwide) from Windows to Linux are successful, or are unsuccessful, but that is only a small factor in the decision.

Answer 2

On first impression, the proposition is vacuously true, depending on your definition of "can". Yes, competition "can" create better quality and lower cost health care. Pedants will pick on this.

Perhaps people feel that you're synthesizing a claim to be examined out of several separate sources, which necessarily injects your own bias.

Another potential source of downvotes is disagreement with your summarization and characterization of the state of the debate. I think you could remove that without affecting the question that you're asking.

I see questions with a lot of explanation as a sign that the asker wants more than verification/falsification of a particular notable claim.

I think that all of these issues would be solved if you pointed to a specific, individual claim to be examined. That would help remove ambiguity about "can", and it would make specific what the claimed benefits of competition are. That would give us something more amenable to skeptical analysis. It would avoid potentially biased characterizations. It would also just be simpler.

Answer 3

I think a good question would focus on the situation in the UK.

What's the exact proposal that they are discussing? What do they mean with "improving competition between hospitals"?

Try to be as specific as possible about what "increase competition between hospitals". Once you are specific you can ask whether that specific "increase competition between hospitals" that they want to try in the UK is benefitial.

Focus on the specific policy that get's proposed in the UK and leave the US out of it.