For the past 20 years, the healthcare policies of successive governments have focused to a large extent on developing a market within the NHS in England. The reasoning behind these moves primarily centred on the hypothesis that if competition, in theory and in practice, has proved to be the greatest single spur to efficiency, quality and innovation in other industries, could it not have the same effect in the NHS? 'Refusing Treatment: the NHS and market-based reform' presents the findings of a year-long, in-depth study into whether and why the NHS market has achieved such results. The study is based on 46 interviews with executives at NHS (foundation) trusts, PCTs, practice-based commissioners and private sector providers, across three health economies in England. Isolated examples of the market having significant positive effects were found. However, by and large, the market is yet to have its intended impact on providers and bring about the anticipated benefits on any meaningful and systematic scale. This is less because the concept of a market is flawed when it comes to the NHS, and more because the market is being distorted and stifled; in particular, by the closed culture of the NHS and powerful, emotive notion of the NHS family. In unprecedentedly tight financial times for the NHS, these findings carry policy implications that should not be ignored.