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

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

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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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
Contact details of provider: Web page: http://www.elsevier.com/locate/inca/505560

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  1. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, MIT Press, vol. 115(2), pages 577-615, May.
  2. Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
  3. 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.
  4. Gaynor, Martin & Moreno-Serra, Rodrigo & Propper, Carol, 2011. "Death by Market Power: Reform, Competition and Patient Outcomes in the National Health Service," CEPR Discussion Papers 8203, C.E.P.R. Discussion Papers.
  5. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2010. "Does hospital competition save lives?: evidence from the English NHS patient choice reforms," LSE Research Online Documents on Economics 28584, London School of Economics and Political Science, LSE Library.
  6. Gregg, Paul & Grout, Paul A. & Ratcliffe, Anita & Smith, Sarah & Windmeijer, Frank, 2011. "How important is pro-social behaviour in the delivery of public services?," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 758-766, August.
  7. Ashton, Toni & Mays, Nicholas & Devlin, Nancy, 2005. "Continuity through change: The rhetoric and reality of health reform in New Zealand," Social Science & Medicine, Elsevier, vol. 61(2), pages 253-262, July.
  8. Carol Propper & Deborah Wilson & Simon Burgess, 2005. "Extending Choice In English Health Care: The implications of the economic evidence," The Centre for Market and Public Organisation 05/133, Department of Economics, University of Bristol, UK.
  9. Carol Propper & Simon Burgess & Denise Gossage, 2008. "Competition and Quality: Evidence from the NHS Internal Market 1991-9," Economic Journal, Royal Economic Society, vol. 118(525), pages 138-170, 01.
  10. Adriana Castelli & Mauro Laudicella & Andrew Street, 2008. "Measuring NHS Output Growth," Working Papers 043cherp, Centre for Health Economics, University of York.
  11. Laudicella, Mauro & Siciliani, Luigi & Cookson, Richard, 2012. "Waiting times and socioeconomic status: Evidence from England," Social Science & Medicine, Elsevier, vol. 74(9), pages 1331-1341.
  12. 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.
  13. Gaynor, Martin, 2007. "Competition and Quality in Health Care Markets," Foundations and Trends(R) in Microeconomics, now publishers, vol. 2(6), pages 441-508, February.
  14. Frey, Bruno S & Oberholzer-Gee, Felix, 1997. "The Cost of Price Incentives: An Empirical Analysis of Motivation Crowding-Out," American Economic Review, American Economic Association, vol. 87(4), pages 746-55, September.
  15. Laudicella, Mauro & Cookson, Richard & Jones, Andrew M. & Rice, Nigel, 2009. "Health care deprivation profiles in the measurement of inequality and inequity: An application to GP fundholding in the English NHS," Journal of Health Economics, Elsevier, vol. 28(6), pages 1048-1061, December.
  16. Le Grand, Julian, 2003. "Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens," OUP Catalogue, Oxford University Press, number 9780199266999, March.
  17. 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.
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