▁explained , ▁ ▁“ In ▁practice , ▁the ▁theoretical ▁advantages ▁of ▁choice ▁are ▁out we ighed ▁by ▁the ▁fact ▁that ▁people ▁don ’ t ▁do ▁a ▁good ▁job ▁of ▁making ▁these ▁choices ▁in ▁a ▁compet itive ▁environment — it ’ s ▁almost ▁impossible .” ▁ ▁In ▁lieu ▁of ▁commercial ▁failure ▁health ▁and ▁social ▁care ▁service ▁regul ators ▁were ▁established , ▁first ▁the ▁Commission ▁for ▁Health ▁Im prov ement , ▁which ▁was ▁replaced ▁by ▁the ▁Health care ▁Commission ▁and ▁then ▁the ▁Care ▁Qu ality ▁Commission . ▁ ▁Cost ▁O pp on ents ▁of ▁the ▁internal ▁market ▁have ▁regularly ▁claimed ▁that ▁the ▁introduction ▁of ▁the ▁internal ▁market ▁increased ▁N HS ▁administration ▁costs ▁from ▁ 5 % ▁to ▁ 1 4 % ▁of ▁total ▁exp end iture . ▁ ▁As ▁a ▁report ▁from ▁York ▁University ▁pointed ▁out ▁" There ▁are ▁no ▁agreed ▁definitions ▁of ▁‘ admin istration ’ ▁and ▁‘ management ’ ▁in ▁health ▁care ▁between ▁( and ▁sometimes ▁even ▁within ) ▁countries ’ ▁health ▁care ▁systems ." ▁Nor ▁is ▁it ▁clear ▁which ▁administrative ▁functions ▁are ▁att rib utable ▁to ▁the ▁ ▁market . ▁▁ ▁Administr ative ▁costs ▁in ▁the ▁N HS ▁were ▁generally ▁thought ▁to ▁be ▁lower ▁than ▁in ▁other ▁systems ▁as ▁there ▁were ▁no ▁systems ▁for ▁b illing ▁patients , ▁and ▁indeed ▁until ▁the ▁advent ▁of ▁the ▁internal ▁market ▁there ▁was ▁little ▁discussion ▁of ▁the ▁costs ▁of ▁treat ments . ▁▁ ▁The ▁number ▁and ▁cost ▁of ▁man agers , ▁administrative ▁and ▁cler ical ▁staff ▁certainly ▁increased ▁significantly ▁between ▁ 1 9 8 8 ▁and