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Performance signals in the public sector: the case of health care

Author

Listed:
  • Hugh Gravelle
  • Peter Smith
  • Ana Xavier

Abstract

Although there are no traditional markets and money prices in the public sector, consumers and providers may respond to signals of organisational performance. We present a simple dynamic model of the demand and supply for elective surgery in the UK National Health Service in which waiting time acts as the prime indicator of performance. The model is tested using a panel of quarterly data for 123 English health authorities over an eight-year period. We find that supply is increasing and demand is decreasing in measures of the previous period waiting time. The results imply that health care systems which are rationed by waiting do respond to indicators of waiting times. The paper adds to the small but consistent body of research which demonstrates that public sector systems respond to important aspects of reported performance. Copyright 2003, Oxford University Press.

Suggested Citation

  • Hugh Gravelle & Peter Smith & Ana Xavier, 2003. "Performance signals in the public sector: the case of health care," Oxford Economic Papers, Oxford University Press, vol. 55(1), pages 81-103, January.
  • Handle: RePEc:oup:oxecpp:v:55:y:2003:i:1:p:81-103
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    Citations

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    Cited by:

    1. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2008. "Competition and waiting times in hospital markets," Journal of Public Economics, Elsevier, vol. 92(7), pages 1607-1628, July.
    2. Siciliani, Luigi, 2006. "A dynamic model of supply of elective surgery in the presence of waiting times and waiting lists," Journal of Health Economics, Elsevier, vol. 25(5), pages 891-907, September.
    3. M. Lippi Bruni & C. Ugolini & R. Verzulli, 2018. "Disentangling the effect of waiting times on hospital choice: Evidence from a panel data analysis," Working Papers wp1118, Dipartimento Scienze Economiche, Universita' di Bologna.
    4. Diane Dawson & Hugh Gravelle & Rowena Jacobs & Stephen Martin & Peter C. Smith, 2007. "The effects of expanding patient choice of provider on waiting times: evidence from a policy experiment," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 113-128.
    5. Luigi Siciliani, 2008. "A note on the dynamic interaction between waiting times and waiting lists," Health Economics, John Wiley & Sons, Ltd., vol. 17(5), pages 639-647.
    6. James Gaughan & Hugh Gravelle & Luigi Siciliani, 2014. "Testing the bed-blocking hypothesis: does higher supply of nursing and care homes reduce delayed hospital discharges?," Working Papers 102cherp, Centre for Health Economics, University of York.
    7. Sofia Dimakou & David Parkin & Nancy Devlin & John Appleby, 2009. "Identifying the impact of government targets on waiting times in the NHS," Health Care Management Science, Springer, vol. 12(1), pages 1-10, March.
    8. Luigi Siciliani & Tor Iversen, 2012. "Waiting Times and Waiting Lists," Chapters,in: The Elgar Companion to Health Economics, Second Edition, chapter 24 Edward Elgar Publishing.
    9. Windrum, Paul & Garci­a-Goñi, Manuel, 2008. "A neo-Schumpeterian model of health services innovation," Research Policy, Elsevier, vol. 37(4), pages 649-672, May.
    10. Fabrizio Iacone & Steve Martin & Luigi Siciliani & Peter C. Smith, 2012. "Modelling the dynamics of a public health care system: evidence from time-series data," Applied Economics, Taylor & Francis Journals, vol. 44(23), pages 2955-2968, August.
    11. Gravelle, Hugh & Siciliani, Luigi, 2008. "Ramsey waits: Allocating public health service resources when there is rationing by waiting," Journal of Health Economics, Elsevier, vol. 27(5), pages 1143-1154, September.
    12. Jacco Thijssen, 2007. "Ramsey Waits: A Computational Study on General Equilibrium Pricing of Derivative Securities," Discussion Papers 07/16, Department of Economics, University of York.
    13. Dixon, Huw & Siciliani, Luigi, 2009. "Waiting-time targets in the healthcare sector: How long are we waiting?," Journal of Health Economics, Elsevier, vol. 28(6), pages 1081-1098, December.
    14. Diane Dawson & Rowena Jacobs & Stephen Martin & Peter Smith, 2006. "The impact of patient choice and waiting time on the demand for health care: results from the London Patient Choice project," Applied Economics, Taylor & Francis Journals, vol. 38(12), pages 1363-1370.
    15. Hugh Gravelle & Luigi Siciliani, 2009. "Third degree waiting time discrimination: optimal allocation of a public sector healthcare treatment under rationing by waiting," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 977-986.
    16. Huw Dixon & Luigi Siciliani, 2009. "Waiting Time Targets in Healthcare Markets: How Long Are We Waiting?," Discussion Papers 09/05, Department of Economics, University of York.
    17. Diane Dawson & Hugh Gravelle & Rowena Jacobs & Stephen Martin & Peter C Smith, 2005. "The effects on waiting times of expanding provider choice:evidence from a policy experiment," Working Papers 001cherp, Centre for Health Economics, University of York.
    18. Luigi Siciliani, 2005. "Does more choice reduce waiting times?," Health Economics, John Wiley & Sons, Ltd., vol. 14(1), pages 17-23.
    19. 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, vol. 26(2), pages 263-285, March.
    20. Frank Windmeijer & Hugh Gravelle & Pierre Hoonhout, 2005. "Waiting lists, waiting times and admissions: an empirical analysis at hospital and general practice level," Health Economics, John Wiley & Sons, Ltd., vol. 14(9), pages 971-985.
    21. 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.
    22. Goddard, John & Tavakoli, Manouche, 2008. "Efficiency and welfare implications of managed public sector hospital waiting lists," European Journal of Operational Research, Elsevier, vol. 184(2), pages 778-792, January.
    23. Dimakou, S. & Parkin, D. & Devlin, N. & Appleby, J., 2006. "The impact of government targets on waiting times for elective surgery: new insights from time-to-event analysis," Working Papers 06/05, Department of Economics, City University London.

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