This is more or less how it works in Israel. The EMR is owned and controlled by the state. Four private HMOs compete (in the literal sense) to provide services as efficiently and high quality as possible, according to their government licenses.
It marries the public sector ability to build giant-ass systems for its citizens, with the private sector's ability to compete. Moving here from Canada I'm beyond shocked how much more efficient, higher quality, and cheaper this system is. I could never go back now.
For example: the second I get a prescription it's available in 100% of the pharmacies in the country (that carry my drug). All I have to do is walk in to the one I want, swipe y card, and ya'ala done. I can even check on an app what pharmacies have said drug in stock, and plot a route there.
1. 4 HMOs total, not hundreds. That's a big difference, it's still pretty centralized.
2. The HMOs actually compete on very little, mostly customer service. They are heavily regulated and have to provide services to a spec that's spelled out by the government, including pricing.
3. These 4 HMOs are mostly historic in origin; starting a new one would probably need to be initiated by the government.
4. For example, your example of (digital) prescriptions being filled by any pharmacy: that's an regulation codified in law. And while 100% of pharmacies can fill it, only those with an arrangement with your HMO will give you the subsidized price.
I'd argue that all I really want them to compete on is customer service. All in all this sounds pretty perfect to me. We get quality care, but some element of competition. I've lived under three different types of systems - this seems by far the best.
It marries the public sector ability to build giant-ass systems for its citizens, with the private sector's ability to compete. Moving here from Canada I'm beyond shocked how much more efficient, higher quality, and cheaper this system is. I could never go back now.
For example: the second I get a prescription it's available in 100% of the pharmacies in the country (that carry my drug). All I have to do is walk in to the one I want, swipe y card, and ya'ala done. I can even check on an app what pharmacies have said drug in stock, and plot a route there.