Trends in health care commissioning in the English NHS: an empirical analysis
AbstractIn recent years there have been marked changes in organisational structures and budgetary arrangements in the English NHS, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and providers. Using data on elective hospital admissions from 1997/98 to 2002/03 we find that commissioning has become significantly more concentrated at PCO and GP level. There was a reduction in the average number of different providers used by PCOs (16.7 to 14.2), an increase in the average share of admissions accounted for by the main provider (49% to 69%), and an increase in the average Herfindahl index (0.35 to 0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations from 100 to 302. The rest was due to mergers amongst providers and the abolition of fundholding. GP fundholding practices which held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their primary care organisation. There was an increase in concentration of admissions for both types of GP practice but fundholders used more providers, had smaller shares at their main provider, and had smaller Herfindahl indices.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoPaper provided by Centre for Health Economics, University of York in its series Working Papers with number 011cherp.
Length: 23 pages
Date of creation: 2006
Date of revision:
concentration; Herfindahl; purchasing; budgets; elective admissions;
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.:
- Propper, Carol, 1996. "Market structure and prices: The responses of hospitals in the UK National Health Service to competition," Journal of Public Economics, Elsevier, vol. 61(3), pages 307-335, September.
- Mark Dusheiko & Hugh Gravelle & Rowena Jacobs, 2004. "The effect of practice budgets on patient waiting times: allowing for selection bias," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 941-958.
- Propper, Carol & Croxson, Bronwyn & Shearer, Arran, 2002.
"Waiting times for hospital admissions: the impact of GP fundholding,"
Journal of Health Economics,
Elsevier, vol. 21(2), pages 227-252, March.
- Croxson, Bronwyn & Propper, Carol & Shearer, Arran, 2000. "Waiting Times for Hospital Admissions: the Impact of GP Fundholding," CEPR Discussion Papers 2489, C.E.P.R. Discussion Papers.
- Mike Damiani & Jennifer Dixon & Carol Propper, 2004. "Mapping choice in the NHS: Analysis of routine data," The Centre for Market and Public Organisation 04/095, Department of Economics, University of Bristol, UK.
- Dranove, David & Lindrooth, Richard, 2003. "Hospital consolidation and costs: another look at the evidence," Journal of Health Economics, Elsevier, vol. 22(6), pages 983-997, November.
- Stephen Martin & Nigel Rice & Peter C Smith, 2007. "The Link Between Health Care Spending and Health Outcomes: Evidence from English Programme Budgeting Data," Working Papers 024cherp, Centre for Health Economics, University of York.
- Siciliani, Luigi & Stanciole, Anderson & Jacobs, Rowena, 2009.
"Do waiting times reduce hospital costs?,"
Journal of Health Economics,
Elsevier, vol. 28(4), pages 771-780, July.
- Luigi Siciliani & Steve Martin, 2007. "An empirical analysis of the impact of choice on waiting times," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 763-779.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Frances Sharp).
If references are entirely missing, you can add them using this form.