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Market structure, patient choice and hospital quality for elective patients

Author

Listed:
  • Giuseppe Moscelli

    (Centre for Health Economics, University of York, York, UK.)

  • Hugh Gravelle

    (Centre for Health Economics, University of York, York, UK.)

  • Luigi Siciliani

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

Abstract

We examine the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England. We allow for time-varying endogeneity due to the effect of unobserved patient characteristics on patient choice of hospital using Two Stage Residual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix.

Suggested Citation

  • Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2016. "Market structure, patient choice and hospital quality for elective patients," Working Papers 139cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:139cherp
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    File URL: https://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP139_market_structure_patient_choice_hospital_quality.pdf
    File Function: First version, 2016
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    References listed on IDEAS

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    Citations

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    Cited by:

    1. Anne-Fleur Roos & Eddy van Doorslaer & Owen O'Donnell & Erik Schut & Marco Varkevisser, 2018. "Does price competition damage healthcare quality?," Tinbergen Institute Discussion Papers 18-040/V, Tinbergen Institute.
    2. repec:eee:socmed:v:216:y:2018:i:c:p:50-58 is not listed on IDEAS
    3. Lisi, D.; Moscone, F.; Tosetti, E.; Vinciotti, V.;, 2017. "Hospital interdependence in a competitive institutional environment: Evidence from Italy," Health, Econometrics and Data Group (HEDG) Working Papers 17/07, HEDG, c/o Department of Economics, University of York.
    4. Anell, Anders & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2017. "Information, Switching Costs, and Consumer Choice: Evidence from Two Randomized Field Experiments in Swedish Primary Health Care," Working Papers 2017:7, Lund University, Department of Economics, revised 27 Jun 2018.
    5. repec:eee:jeborg:v:153:y:2018:i:c:p:322-344 is not listed on IDEAS
    6. Dardanoni, V.; & Laudicella, M.; & Li Donni, P.;, 2018. "Hospital Choice in the NHS," Health, Econometrics and Data Group (HEDG) Working Papers 18/04, HEDG, c/o Department of Economics, University of York.
    7. Moscelli, Giuseppe & Gravelle, Hugh & Siciliani, Luigi & Gutacker, Nils, 2018. "The effect of hospital ownership on quality of care: Evidence from England," Journal of Economic Behavior & Organization, Elsevier, vol. 153(C), pages 322-344.

    More about this item

    Keywords

    competition; quality; hospital; choice; electives.;

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L32 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Public Enterprises; Public-Private Enterprises
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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