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Does hospital competition harm equity? Evidence from the English National Health Service

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  • Cookson, Richard
  • Laudicella, Mauro
  • Donni, Paolo Li

Abstract

Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market competition and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity.

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Bibliographic Info

Article provided by Elsevier in its journal Journal of Health Economics.

Volume (Year): 32 (2013)
Issue (Month): 2 ()
Pages: 410-422

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Handle: RePEc:eee:jhecon:v:32:y:2013:i:2:p:410-422

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Web page: http://www.elsevier.com/locate/inca/505560

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Keywords: Competition; Hospital; Inequality;

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References

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  13. Cookson, Richard & Laudicella, Mauro & Donni, Paolo Li, 2012. "Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008," Social Science & Medicine, Elsevier, vol. 75(8), pages 1514-1522.
  14. Cookson, Richard & Laudicella, Mauro, 2011. "Do the poor cost much more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001 to 2008," Social Science & Medicine, Elsevier, vol. 72(2), pages 173-184, January.
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