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Hospital Choice in the NHS

Author

Listed:
  • Dardanoni, V.;
  • Laudicella, M.;
  • Li Donni, P.;

Abstract

We study hospital choice in the publicly funded National Health Service in England, using a two sample strategy to identify a structural model of demand for elective procedures. In the NHS patients are allowed to opt out from the market of free-of-charge public hospitals and choose a private provider; we find that the outside option has an important effect on competition, patient choice and elasticities compared with traditional models ignoring the private sector. Considering endogeneity of waiting-time, proper measures of quality and the existence of private sector, we find substantially different policy conclusions compared to existing hospital demand models.

Suggested Citation

  • 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.
    • Handle: RePEc:yor:hectdg:18/04
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    References listed on IDEAS

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    1. Laudicella, Mauro & Li Donni, Paolo & Smith, Peter C., 2013. "Hospital readmission rates: Signal of failure or success?," Journal of Health Economics, Elsevier, vol. 32(5), pages 909-921.
    2. Gaynor, Martin & Laudicella, Mauro & Propper, Carol, 2012. "Can governments do it better? Merger mania and hospital outcomes in the English NHS," Journal of Health Economics, Elsevier, vol. 31(3), pages 528-543.
    3. Puck Beukers & Ron Kemp & Marco Varkevisser, 2014. "Patient hospital choice for hip replacement: empirical evidence from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 927-936, December.
    4. Walter Beckert & Mette Christensen & Kate Collyer, 2012. "Choice of NHS‐funded Hospital Services in England," Economic Journal, Royal Economic Society, vol. 122(560), pages 400-417, May.
    5. Leemore Dafny, 2009. "Estimation and Identification of Merger Effects: An Application to Hospital Mergers," Journal of Law and Economics, University of Chicago Press, vol. 52(3), pages 523-550, August.
    6. Michael Noble & Gemma Wright & George Smith & Chris Dibben, 2006. "Measuring Multiple Deprivation at the Small-Area Level," Environment and Planning A, , vol. 38(1), pages 169-185, January.
    7. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    8. Aviv Nevo, 2011. "Empirical Models of Consumer Behavior," Annual Review of Economics, Annual Reviews, vol. 3(1), pages 51-75, September.
    9. Steven Berry & James Levinsohn & Ariel Pakes, 2004. "Differentiated Products Demand Systems from a Combination of Micro and Macro Data: The New Car Market," Journal of Political Economy, University of Chicago Press, vol. 112(1), pages 68-105, February.
    10. Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2015. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 82(2), pages 457-489.
    11. J. Levin & L. Einav, 2012. "Empirical Industrial Organization: A Progress Report," Voprosy Ekonomiki, NP Voprosy Ekonomiki, issue 1.
    12. Pakes, Ariel & Pollard, David, 1989. "Simulation and the Asymptotics of Optimization Estimators," Econometrica, Econometric Society, vol. 57(5), pages 1027-1057, September.
    13. Peter Sivey, 2012. "The effect of waiting time and distance on hospital choice for English cataract patients," Health Economics, John Wiley & Sons, Ltd., vol. 21(4), pages 444-456, April.
    14. Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Gravelle, Hugh, 2016. "Location, quality and choice of hospital: Evidence from England 2002–2013," Regional Science and Urban Economics, Elsevier, vol. 60(C), pages 112-124.
    15. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 577-615.
    16. Kenneth E. Train & Clifford Winston, 2007. "Vehicle Choice Behavior And The Declining Market Share Of U.S. Automakers," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 48(4), pages 1469-1496, November.
    17. repec:imp:wpaper:9224 is not listed on IDEAS
    18. Katherine Ho, 2009. "Insurer-Provider Networks in the Medical Care Market," American Economic Review, American Economic Association, vol. 99(1), pages 393-430, March.
    19. Austan Goolsbee & Amil Petrin, 2004. "The Consumer Gains from Direct Broadcast Satellites and the Competition with Cable TV," Econometrica, Econometric Society, vol. 72(2), pages 351-381, March.
    20. Capps, Cory & Dranove, David & Satterthwaite, Mark, 2003. "Competition and Market Power in Option Demand Markets," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 737-763, Winter.
    21. Katherine Ho, 2006. "The welfare effects of restricted hospital choice in the US medical care market," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 21(7), pages 1039-1079.
    22. Walter Beckert & Elaine Kelly, 2017. "Divided by choice? Private providers, patient choice and hospital sorting in the English National Health service," IFS Working Papers W17/15, Institute for Fiscal Studies.
    23. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    24. Carol Propper & Simon Burgess & Denise Gossage, 2008. "Competition and Quality: Evidence from the NHS Internal Market 1991–9," Economic Journal, Royal Economic Society, vol. 118(525), pages 138-170, January.
    25. Amil Petrin, 2002. "Quantifying the Benefits of New Products: The Case of the Minivan," Journal of Political Economy, University of Chicago Press, vol. 110(4), pages 705-729, August.
    26. Guido W. Imbens & Tony Lancaster, 1994. "Combining Micro and Macro Data in Microeconometric Models," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 61(4), pages 655-680.
    27. Elaine Kelly & George Stoye, 2015. "New joints: private providers and rising demand in the English National Health Service," IFS Working Papers W15/22, Institute for Fiscal Studies.
    28. Berry, Steven & Levinsohn, James & Pakes, Ariel, 1995. "Automobile Prices in Market Equilibrium," Econometrica, Econometric Society, vol. 63(4), pages 841-890, July.
    29. 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.
    30. repec:ecj:econjl:v:122:y:2012:i::p:400-417 is not listed on IDEAS
    31. Gaynor, Martin, 2007. "Competition and Quality in Health Care Markets," Foundations and Trends(R) in Microeconomics, now publishers, vol. 2(6), pages 441-508, February.
    32. repec:wly:hlthec:v:26:y:2017:i::p:92-105 is not listed on IDEAS
    33. 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.
    34. Hugh Gravelle & Rita Santos & Luigi Siciliani & Rosalind Goudie, 2012. "Hospital Quality Competition Under Fixed Prices," Working Papers 080cherp, Centre for Health Economics, University of York.
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    Cited by:

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    2. Levaggi, Laura & Levaggi, Rosella, 2020. "Is there scope for mixed markets in the provision of hospital care?," Social Science & Medicine, Elsevier, vol. 247(C).
    3. Orestis Papadopoulos & Marti Lopez‐Andreu & Mandi Jamalian, 2021. "Violation and lack of awareness of employment rights in the United Kingdom's hotel industry: Isolation, fragmentation and barriers to labour enforcement," Industrial Relations Journal, Wiley Blackwell, vol. 52(4), pages 315-330, July.
    4. Oana NICORICI MIRON, 2022. "Health Policies In Contemporary Romania. Current Empirical Elements And Development Perspectives," Internal Auditing and Risk Management, Athenaeum University of Bucharest, vol. 66(2), pages 64-80, September.
    5. S. Balia & R. Brau & D. Moro, 2018. "Hospital choice with high long-distance mobility," Working Paper CRENoS 201810, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    6. Levaggi, Laura & Levaggi, Rosella, 2023. "Competition in the provision of hospital care: Are mixed markets a valid alternative?," Economic Modelling, Elsevier, vol. 127(C).

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    More about this item

    Keywords

    hospital demand; patient choice; quality; NHS;
    All these keywords.

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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