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An empirical analysis of the impact of choice on waiting times

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Author Info
Luigi Siciliani (Department of Economics and Related Studies, University of York, UK)
Steve Martin (Department of Economics and Related Studies, University of York, UK)

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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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File URL: http://hdl.handle.net/10.1002/hec.1205
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Publisher Info
Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 16 (2007)
Issue (Month): 8 ()
Pages: 763-779
Download reference. The following formats are available: HTML (with abstract), plain text (with abstract), BibTeX, RIS (EndNote, RefMan, ProCite), ReDIF
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. Richard Blundell & Frank Windmeijer, 2000. "Identifying demand for health resources using waiting times information," IFS Working Papers W00/03, Institute for Fiscal Studies. [Downloadable!]
    Other versions:
  2. J.A. Goddard & M. Tavakoli, 1998. "Referral rates and waiting lists: some empirical evidence," Health Economics, John Wiley & Sons, Ltd., vol. 7(6), pages 545-549.
  3. 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, vol. 166(3), pages 369-387. [Downloadable!] (restricted)
  4. 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, Directorate for Employment, Labour and Social Affairs. [Downloadable!]
  5. Iversen, Tor, 1997. "The effect of a private sector on the waiting time in a national health service," Journal of Health Economics, Elsevier, vol. 16(4), pages 381-396, August. [Downloadable!] (restricted)
  6. 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, vol. 88(7-8), pages 1247-1272, July. [Downloadable!] (restricted)
  7. Mireia Jofre-Bonet, 2000. "Public health care and private insurance demand: The waiting time as a link," Health Care Management Science, Springer, vol. 3(1), pages 51-71, January. [Downloadable!] (restricted)
  8. Mark Dusheiko & Maria Goddard & Hugh Gravelle & Rowena Jacobs, 2006. "Trends in health care commissioning in the English NHS: an empirical analysis," Working Papers 011cherp, Centre for Health Economics, University of York. [Downloadable!]
  9. Julian Le Grand, 2002. "The Labour Government and the National Health Service," Oxford Review of Economic Policy, Oxford University Press, vol. 18(2), pages 137-153, June.
  10. Besley, Timothy & Hall, John & Preston, Ian, 1998. "Private and public health insurance in the UK," European Economic Review, Elsevier, vol. 42(3-5), pages 491-497, May. [Downloadable!] (restricted)
  11. Manning, Willard G. & Mullahy, John, 2001. "Estimating log models: to transform or not to transform?," Journal of Health Economics, Elsevier, vol. 20(4), pages 461-494, July. [Downloadable!] (restricted)
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  12. 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., vol. 7(3), pages 187-197.
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Kurt R. Brekke & Luigi Siciliani & Odd Rune Straume, 2007. "Competition and Waiting Times in Hospital Markets," CESifo Working Paper Series CESifo Working Paper No. , CESifo Group Munich. [Downloadable!]
    Other versions:
  2. Luigi Siciliani, Anderson Stanciole, Rowena Jacobs, 2008. "Do waiting times reduce hospital costs?," Discussion Papers 08/02, Department of Economics, University of York. [Downloadable!]
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