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An empirical analysis of the impact of choice on waiting times

  • Luigi Siciliani

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

  • Steve Martin

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

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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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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  1. 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.
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  13. 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.
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