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An empirical analysis of the impact of choice on waiting times

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  • Luigi Siciliani

    (Department of Economics and Related Studies, University of York, UK)

  • Steve Martin

    (Department of Economics and Related Studies, University of York, UK)

Abstract

Policy-makers often claim that enhancing patient choice induces more competition among hospitals and may therefore reduce waiting times. This paper tests this claim using 120 English NHS hospitals over the period 1999-2001. Several proxies for the degree of choice (or competition) are constructed including: (a) the number of hospitals within the catchment area of each hospital; (b) the number of hospitals in the catchment area of each hospital standardised by the population of the catchment area; (c) the inverse of the Herfindahl index (or 'the number of effective competitors'). Several control variables are included: the availability of doctors, junior doctors, nurses, and other personnel; the availability of acute beds; the emergency admission rate; the day-case rate; the average length of inpatient stay; an indicator of case-mix; and mortality and re-admission rates. We find that more choice is significantly associated with lower waiting times at the sample mean (five hospitals) although the quantitative effect is modest: an extra hospital in a catchment area will only reduce waiting by at most a few days (or 1-2% reduction in waiting). There is also some evidence that increases in choice can boost waiting times when the degree of choice is very high (i.e. more than 11 hospitals are included in the catchment area). Copyright © 2007 John Wiley & Sons, Ltd.

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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 16 (2007)
Issue (Month): 8 ()
Pages: 763-779

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Handle: RePEc:wly:hlthec:v:16:y:2007:i:8:p:763-779

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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  1. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, Elsevier, vol. 88(7-8), pages 1247-1272, July.
  2. Jeremy Hurst & Luigi Siciliani, 2003. "Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries," OECD Health Working Papers 6, OECD Publishing.
  3. Willard G. Manning & John Mullahy, 1999. "Estimating Log Models: To Transform or Not to Transform?," NBER Technical Working Papers, National Bureau of Economic Research, Inc 0246, National Bureau of Economic Research, Inc.
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  5. Carol Propper & Neil Söderlund, 1998. "Competition in the NHS internal market: an overview of its effects on hospital prices and costs," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 7(3), pages 187-197.
  6. Besley, Timothy & Hall, John & Preston, Ian, 1998. "Private and public health insurance in the UK," European Economic Review, Elsevier, Elsevier, vol. 42(3-5), pages 491-497, May.
  7. Mark Dusheiko & Maria Goddard & Hugh Gravelle & Rowena Jacobs, 2006. "Trends in health care commissioning in the English NHS: an empirical analysis," Working Papers, Centre for Health Economics, University of York 011cherp, Centre for Health Economics, University of York.
  8. J.A. Goddard & M. Tavakoli, 1998. "Referral rates and waiting lists: some empirical evidence," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 7(6), pages 545-549.
  9. Julian Le Grand, 2002. "The Labour Government and the National Health Service," Oxford Review of Economic Policy, Oxford University Press, Oxford University Press, vol. 18(2), pages 137-153, June.
  10. Pope, Gregory C., 1989. "Hospital nonprice competition and medicare reimbursement policy," Journal of Health Economics, Elsevier, Elsevier, vol. 8(2), pages 147-172, June.
  11. Iversen, Tor, 1997. "The effect of a private sector on the waiting time in a national health service," Journal of Health Economics, Elsevier, Elsevier, vol. 16(4), pages 381-396, August.
  12. Stephen Martin & Peter C. Smith, 2003. "Using panel methods to model waiting times for National Health Service surgery," Journal of the Royal Statistical Society Series A, Royal Statistical Society, Royal Statistical Society, vol. 166(3), pages 369-387.
  13. Dranove, David & Satterthwaite, Mark A., 2000. "The industrial organization of health care markets," Handbook of Health Economics, Elsevier, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 20, pages 1093-1139 Elsevier.
  14. Mireia Jofre-Bonet, 2000. "Public health care and private insurance demand: The waiting time as a link," Health Care Management Science, Springer, Springer, vol. 3(1), pages 51-71, January.
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Cited by:
  1. Dixon, Huw & Siciliani, Luigi, 2009. "Waiting-time targets in the healthcare sector: How long are we waiting?," Journal of Health Economics, Elsevier, Elsevier, vol. 28(6), pages 1081-1098, December.
  2. Kurt R. Brekke & Luigi Siciliani & Odd Rune Straume, 2007. "Competition and Waiting Times in Hospital Markets," NIPE Working Papers, NIPE - Universidade do Minho 9/2007, NIPE - Universidade do Minho.
  3. Siciliani, Luigi & Stanciole, Anderson & Jacobs, Rowena, 2009. "Do waiting times reduce hospital costs?," Journal of Health Economics, Elsevier, Elsevier, vol. 28(4), pages 771-780, July.
  4. Dewenter, Ralf & Jaschinski, Thomas & Kuchinke, Björn A., 2012. "Hospital market concentration and discrimination of patients," DICE Discussion Papers 63, Heinrich‐Heine‐Universität Düsseldorf, Düsseldorf Institute for Competition Economics (DICE).
  5. Meliyanni Johar & Glenn Jones & Michael P. Keane & Elizabeth Savage & Olena Stavrunova, 2012. "Discrimination in a universal health system: Explaining socioeconomic waiting time gaps," Economics Papers 2012-W11, Economics Group, Nuffield College, University of Oxford.
  6. Mark Stabile & Sarah Thomson, 2014. "The Changing Role of Government in Financing Health Care: An International Perspective," Journal of Economic Literature, American Economic Association, American Economic Association, vol. 52(2), pages 480-518, June.
  7. Martin, Stephen & Rice, Nigel & Jacobs, Rowena & Smith, Peter, 2007. "The market for elective surgery: Joint estimation of supply and demand," Journal of Health Economics, Elsevier, Elsevier, vol. 26(2), pages 263-285, March.

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