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Do hospitals respond to greater autonomy? Evidence from the English NHS

Author

Listed:
  • Rossella Verzulli

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

  • Rowena Jacobs

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

  • Maria Goddard

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

Abstract

Foundation Trusts (FTs) were introduced in the English NHS in 2004/5 and gave NHS Trusts the opportunity to become independent not-for-profit public benefit corporations. Whilst remaining in the public sector, FTs were granted greater autonomy than non-FTs. The reform was intended to create incentives for providers to deliver higher quality services in the most efficient way. This paper examines the impact of the FT policy on hospital performance, as proxied by measures of financial management, quality of care and staff satisfaction. Results suggest that generally FTs perform better than non-FTs. However, these differences appear to be long-standing rather than the effect of the FT policy per se and we find some evidence of a convergence in hospital performance between FTs and non-FTs.

Suggested Citation

  • Rossella Verzulli & Rowena Jacobs & Maria Goddard, 2011. "Do hospitals respond to greater autonomy? Evidence from the English NHS," Working Papers 064cherp, Centre for Health Economics, University of York.
  • Handle: RePEc:chy:respap:64cherp
    as

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    File URL: http://www.york.ac.uk/media/che/documents/papers/researchpapers/RP64_Foundation_Trusts.pdf
    File Function: First version, 2011
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    References listed on IDEAS

    as
    1. Giorgia Marini & Marisa Miraldo & Rowena Jacobs & Maria Goddard, 2008. "Giving greater financial independence to hospitals-does it make a difference? The case of English NHS Trusts," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 751-775.
    2. George France & Francesco Taroni & Andrea Donatini, 2005. "The Italian health-care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 187-202.
    3. 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.
    4. 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.
    5. Allen, Pauline, 2006. "New localism in the English National Health Service: What is it for?," Health Policy, Elsevier, vol. 79(2-3), pages 244-252, December.
    6. Rowena Jacobs & Diane Dawson, 2003. "Hospital efficiency targets," Health Economics, John Wiley & Sons, Ltd., vol. 12(8), pages 669-684.
    7. Sascha O. Becker & Andrea Ichino, 2002. "Estimation of average treatment effects based on propensity scores," Stata Journal, StataCorp LP, vol. 2(4), pages 358-377, November.
    Full references (including those not matched with items on IDEAS)

    Citations

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    Cited by:

    1. Adriana Castelli & Andrew Street & Rossella Verzulli & Padraic Ward, 2015. "Examining variations in hospital productivity in the English NHS," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(3), pages 243-254, April.
    2. Maria Jose Aragon Aragon & Adriana Castelli & James Gaughan, 2015. "Hospital trusts productivity in the English NHS: uncovering possible drivers of productivity variations," Working Papers 117cherp, Centre for Health Economics, University of York.
    3. Joan Costa‐Font & Edward C. Norton & Luigi Siciliani & James Gaughan & Hugh Gravelle & Luigi Siciliani, 2017. "Delayed Discharges and Hospital Type: Evidence from the English NHS," Fiscal Studies, Institute for Fiscal Studies, vol. 38, pages 495-519, September.
    4. Rossella Verzulli & Gianluca Fiorentini & Matteo Lippi Bruni & Cristina Ugolini, 2017. "Price Changes in Regulated Healthcare Markets: Do Public Hospitals Respond and How?," Health Economics, John Wiley & Sons, Ltd., vol. 26(11), pages 1429-1446, November.
    5. Eleonora Fichera & Hugh Gravelle & Mario Pezzino & Matt Sutton, 2016. "Quality target negotiation in health care: evidence from the English NHS," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(7), pages 811-822, September.
    6. Johannessen, Karl Arne & Kittelsen, Sverre A.C. & Hagen, Terje P., 2017. "Assessing physician productivity following Norwegian hospital reform: A panel and data envelopment analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 117-126.

    More about this item

    Keywords

    Foundation Trusts; hospital reform; performance indicators;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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