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Did 'Targets and Terror' Reduce Waiting times in England for Hospital Care?

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  • Carol Propper
  • Matt Sutton
  • Carolyn Whitnall
  • Frank Windmeijer

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Abstract

Waiting times have been a central concern in the English NHS, where care is provided free at the point of delivery and is rationed by waiting time. Pro-market reforms introduced in the NHS in the 1990s were not accompanied by large drops in waiting times. As a result, the English government in 2000 adopted the use of an aggressive policy of targets coupled with publication of waiting times data at hospital level and strong sanctions for poor performing hospital managers. This regime has been dubbed ‘targets and terror’. We estimate the effect of the English target regime for waiting times for hospital care after 2001 by a comparative analysis with Scotland, a neighbouring country with the same healthcare system that did not adopt the target regime. We estimate difference-in-differences models of the proportion of people on the waiting list who waited over 6, 9 and 12 months. Comparisons between England and Scotland are sensitive to whether published or unpublished data are used but, regardless of the data source, the ‘targets and terror’ regime in England lowered the proportion of people waiting for elective treatment relative to Scotland.

Suggested Citation

  • Carol Propper & Matt Sutton & Carolyn Whitnall & Frank Windmeijer, 2007. "Did 'Targets and Terror' Reduce Waiting times in England for Hospital Care?," The Centre for Market and Public Organisation 07/179, Department of Economics, University of Bristol, UK.
  • Handle: RePEc:bri:cmpowp:07/179
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    File URL: http://www.bris.ac.uk/Depts/CMPO/workingpapers/wp179.pdf
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    References listed on IDEAS

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    Cited by:

    1. Besley, Timothy J. & Bevan, Gwyn & Burchardi, Konrad B., 2009. "Naming & Shaming: The impacts of different regimes on hospital waiting times in England and Wales," CEPR Discussion Papers 7306, C.E.P.R. Discussion Papers.
    2. Siciliani, Luigi & Moran, Valerie & Borowitz, Michael, 2014. "Measuring and comparing health care waiting times in OECD countries," Health Policy, Elsevier, vol. 118(3), pages 292-303.
    3. Burgess, Simon & Wilson, Deborah & Worth, Jack, 2013. "A natural experiment in school accountability: The impact of school performance information on pupil progress," Journal of Public Economics, Elsevier, vol. 106(C), pages 57-67.
    4. Gutacker, Nils & Siciliani, Luigi & Cookson, Richard, 2016. "Waiting time prioritisation: Evidence from England," Social Science & Medicine, Elsevier, vol. 159(C), pages 140-151.
    5. Cookson R & Laudicella M, 2009. "Do the poor still cost more? The relationship between small area income deprivation and length of stay for elective hip replacement in the English NHS from 2001/2 to 2006/7," Health, Econometrics and Data Group (HEDG) Working Papers 09/07, HEDG, c/o Department of Economics, University of York.
    6. 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.
    7. Richard Cookson & Mauro Laudicella & Paolo Li Donni, 2011. "Measuring change in health care equity using small area administrative data – evidence from the English NHS 2001-8," Working Papers 067cherp, Centre for Health Economics, University of York.
    8. 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.
    9. Silviya Nikolova; & Arthur Sinko; & Matt Sutton;, 2012. "Do maximum waiting times guarantees change clinical priorities? A Conditional Density Estimation approach," Health, Econometrics and Data Group (HEDG) Working Papers 12/07, HEDG, c/o Department of Economics, University of York.
    10. Martin Gaynor & Carol Propper & Stephan Seiler, 2012. "Free to Choose? Reform and Demand Response in the English National Health Service," The Centre for Market and Public Organisation 12/297, Department of Economics, University of Bristol, UK.
    11. repec:eee:jhecon:v:58:y:2018:i:c:p:123-143 is not listed on IDEAS
    12. Moscelli, Giuseppe & Siciliani, Luigi & Tonei, Valentina, 2016. "Do waiting times affect health outcomes? Evidence from coronary bypass," Social Science & Medicine, Elsevier, vol. 161(C), pages 151-159.
    13. 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.
    14. Martin Gaynor & Carol Propper & Stephan Seiler, 2016. "Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service," American Economic Review, American Economic Association, vol. 106(11), pages 3521-3557, November.
    15. Besley, Timothy & Burchardi, Konrad B. & Bevan, Gwen, 2009. "Naming and shaming: the impacts of different regimes on hospital waiting times in England and Wales," LSE Research Online Documents on Economics 33775, London School of Economics and Political Science, LSE Library.
    16. Houyuan Jiang & Zhan Pang & Sergei Savin, 2017. "Improving Patient Access to Care: Performance Incentives and Competition in Healthcare Markets," Working Papers 2017/01, Cambridge Judge Business School, University of Cambridge.
    17. Nikolova, Silviya & Sinko, Arthur & Sutton, Matt, 2015. "Do maximum waiting times guarantees change clinical priorities for elective treatment? Evidence from Scotland," Journal of Health Economics, Elsevier, vol. 41(C), pages 72-88.
    18. 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.
    19. Propper, Carol & Sutton, Matt & Whitnall, Carolyn & Windmeijer, Frank, 2010. "Incentives and targets in hospital care: Evidence from a natural experiment," Journal of Public Economics, Elsevier, vol. 94(3-4), pages 318-335, April.
    20. Januleviciute, Jurgita & Askildsen, Jan Erik & Kaarboe, Oddvar & Holmås, Tor Helge & Sutton, Matt, 2013. "The impact of different prioritisation policies on waiting times: Case studies of Norway and Scotland," Social Science & Medicine, Elsevier, vol. 97(C), pages 1-6.

    More about this item

    Keywords

    health care; waiting times; targets;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L32 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Public Enterprises; Public-Private Enterprises

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