Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms
AbstractThis paper examines whether or not hospital competition in a market with fixed reimbursement prices can prompt improvements in clinical quality. In January 2006, the British Government introduced a major extension of their market-based reforms to the English National Health Service. From January 2006 onwards, every patient in England could choose their hospital for secondary care and hospitals had to compete with each other to attract patients to secure their revenue. One of the central aims of this policy was to create financial incentives for providers to improve their clinical performance. This paper assesses whether this aim has been achieved and competition led to improvements in quality. For our estimation, we exploit the fact that choice-based reforms will create sharper financial incentives for hospitals in markets where choice is geographically feasible and that prior to 2006, in the absence of patient choice, hospitals had no direct financial incentive to improve performance in order to attract more patients. We use a modified difference-in-difference estimator to analyze whether quality improved more quickly in more competitive markets after the government introduced its new wave of market-based reforms. Using AMI mortality as a quality indicator, we find that mortality fell more quickly (i.e. quality improved) for patients living in more competitive markets after the introduction of hospital competition in January 2006. Our results suggest that hospital competition in markets with fixed prices can lead to improvements in clinical quality.
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Bibliographic InfoArticle provided by Royal Economic Society in its journal The Economic Journal.
Volume (Year): 121 (2011)
Issue (Month): 554 (08)
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Other versions of this item:
- Zack Cooper & Steve Gibbons & Simon Jones & Alistair McGuire, 2010. "Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms," SERC Discussion Papers 0041, Spatial Economics Research Centre, LSE.
- I1 - Health, Education, and Welfare - - Health
- L1 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance
- R0 - Urban, Rural, Regional, Real Estate, and Transportation Economics - - General
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- Gaynor, Martin & Laudicella, Mauro & Propper, Carol, 2012.
"Can governments do it better? Merger mania and hospital outcomes in the English NHS,"
Journal of Health Economics,
Elsevier, vol. 31(3), pages 528-543.
- Martin Gaynor & Mauro Laudicella & Carol Propper, 2011. "Can Governments Do It Better? Merger Mania and Hospital Outcomes in the English NHS," NBER Working Papers 17608, National Bureau of Economic Research, Inc.
- Propper, C & Laudicella, M & Gaynor, M, 2012. "Can governments do it better? Merger mania and hospital outcomes in the English NHS," Working Papers 9183, Imperial College, London, Imperial College Business School.
- Propper, C & Laudicella, M & Gaynor, M, 2012. "Can governments do it better? Merger mania and hospital outcomes in the English NHS," Working Papers 9182, Imperial College, London, Imperial College Business School.
- Gaynor, Martin & Laudicella, Mauro & Propper, Carol, 2012. "Can governments do it better? Merger mania and hospital outcomes in the English NHS," CEPR Discussion Papers 8802, C.E.P.R. Discussion Papers.
- Propper, C & Laudicella, M & Gaynor, M, 2012. "Can governments do it better? Merger mania and hospital outcomes in the English NHS," Working Papers 9184, Imperial College, London, Imperial College Business School.
- Martin Gaynor & Mauro Laudicella & Carol Propper, 2012. "Can governments do it better? Merger mania and hospital outcomes in the English NHS," The Centre for Market and Public Organisation 12/281, Department of Economics, University of Bristol, UK.
- Dan Corry & Anna Valero & John Van Reenen, 2011.
"UK Economic Performance Since 1997: Growth, Productivity and Jobs,"
CEP Special Papers
24, Centre for Economic Performance, LSE.
- Corry, Dan & Valero, Anna & Van Reenen, John, 2011. "UK economic performance since 1997: growth, productivity and jobs ," Open Access publications from London School of Economics and Political Science CEPSP24, London School of Economics and Political Science.
- Hugh Gravelle & Rita Santos & Luigi Siciliani, 2013. "Does a hospitals quality depend on the quality of other hospitals? A spatial econometrics approach to investigating hospital quality competition," Working Papers 082cherp, Centre for Health Economics, University of York.
- Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2012. "Does Competition Improve Public Hospitals' Efficiency? Evidence from a Quasi-Experiment in the English National Health Service," CEP Discussion Papers dp1125, Centre for Economic Performance, LSE.
- Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2013.
"Hospital Mergers: A Spatial Competition Approach,"
Discussion Paper Series in Economics
8/2013, Department of Economics, Norwegian School of Economics.
- Rita Santos & Hugh Gravelle & Carol Propper, 2013. "Does quality affect patientsâ€™ choice of doctor? Evidence from the UK," Working Papers 088cherp, Centre for Health Economics, University of York.
- Hugh Gravelle & Rita Santos & Luigi Siciliani & Rosalind Goudie, 2012. "Hospital Quality Competition Under Fixed Prices," Working Papers 080cherp, Centre for Health Economics, University of York.
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