The responsibility of patient care costs could be put on GPs under plans laid out by the Conservatives.
The move would open up competition between hospitals, private companies and charities for NHS patients giving doctors a "direct incentive" to buy the most efficient services, shadow health secretary Andrew Lansley said.
He added: "With part of GPs' pay dependent upon the results of their patient's treatment, they will have a direct incentive to buy the most efficient services on behalf of their patients, because they will be able to keep any savings and use them to reinvest in their patient's care."
With public finances in "crisis", Mr Lansley said that the delivery of a fair, competent and excellent NHS was a great challenge.
Writing in Policy Review magazine, he said: "We will drive efficiency by opening up the NHS to allow charities and private organisations to compete to provide NHS services if they meet the necessary high-quality standards."
Health minister, Mike O'Brien, said that NHS acute and specialist trusts were becoming more efficient.
He added: "Over the years we have invested in an extra 40,000 doctors and 80,000 extra nurses as well as over 100 new hospitals and almost 100 GP health centres."
"Bad idea once you bring in the private sector - you make medicine into a business which it is not. How do you measure true efficiency? Will GPs buy the best services or what fits their budgets? Do GPs want all this hassle of being business managers? Surely the NHS should be patient led not business led" - Josette Oliver-Jones, East Sussex