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Assessing Welfare Effects of the European Choice Agenda: The case of health care in the United Kingdom


  • Valentina Zigante


Choice and competition policies in public services are popular reform strategies in the member states of the European Union (EU). The European choice agenda is based on the view in the EU of ‘social policy as a productive factor’ and the need for ‘modernisation’ of the EU welfare states. This user-led, consumer oriented approach highlights the need to understand the effects of the choice and competition policies in public service. In conventional welfare economic the focus lies on analysis of efficiency, quality and equity effects and the current empirical evidence show varying results. This paper discusses choice policies in European countries and uses the case of choice in health care in the UK is to assess the welfare effects of choice and competition. The UK has a highly developed consumerist policy, and as it has served as a role model for other European countries implementing choice policies. The welfare effects are assessed using satisfaction with the NHS and subjective well-being as an indicator of individual welfare, gained from the introduction of choice of hospital in 2006. Further the equity aspect of choice is assessed by analysing variation in welfare effects between socio economic groups. The results indicate positive effects of choice, particularly for middle class individuals.

Suggested Citation

  • Valentina Zigante, 2011. "Assessing Welfare Effects of the European Choice Agenda: The case of health care in the United Kingdom," LEQS – LSE 'Europe in Question' Discussion Paper Series 35, European Institute, LSE.
  • Handle: RePEc:eiq:eileqs:35

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    References listed on IDEAS

    1. Ng, Yew-Kwang, 1988. "Economic Efficiency versus Egalitarian Rights," Kyklos, Wiley Blackwell, vol. 41(2), pages 215-237.
    2. Barr, Nicholas, 2001. "The Welfare State as Piggy Bank: Information, Risk, Uncertainty, and the Role of the State," OUP Catalogue, Oxford University Press, number 9780199246595.
    3. Cabiedes, Laura & Guillén, Ana, 2001. "Adopting and adapting managed competition: health care reform in Southern Europe," Social Science & Medicine, Elsevier, vol. 52(8), pages 1205-1217, April.
    4. Joan Costa-Font & Joan Rovira, 2005. "Eliciting preferences for collectively financed health programmes: the 'willingness to assign' approach," Applied Economics, Taylor & Francis Journals, vol. 37(14), pages 1571-1583.
    5. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    6. Frijters, Paul, 2000. "Do individuals try to maximize general satisfaction?," Journal of Economic Psychology, Elsevier, vol. 21(3), pages 281-304, June.
    7. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1247-1272, July.
    8. Ada Ferrer-i-Carbonell & Paul Frijters, 2004. "How Important is Methodology for the estimates of the determinants of Happiness?," Economic Journal, Royal Economic Society, vol. 114(497), pages 641-659, July.
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