Does Hospital Competition Save Lives? Evidence From The Recent English NHS Choice Reforms
نویسندگان
چکیده
This paper examines whether or not hospital competition in a market with fixed reimbursement prices can prompt improvements in clinical quality. In January 2006, the British government introduced a major extension of their market-based reforms to the English National Health Service. From January 2006 onwards, every patient in England could choose their hospital for secondary care, and hospitals had to compete with each other to attract patients to secure their revenue. In order to estimate the impact of hospital competition, we exploit the fact that choice-based reforms will have had more ‘bite’ in places where choice is geographically feasible. We use a modified difference-indifference estimator to analyze whether quality improved more quickly in more competitive markets after the government introduced its new wave of market-based reforms. Using AMI mortality as a quality indicator, we find that mortality fell more quickly (i.e. quality improved) for patients living in more competitive markets after the introduction of hospital competition in January 2006. Our results suggest that hospital competition in markets with fixed prices can lead to improvements in clinical quality.
منابع مشابه
Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms*
Recent substantive reforms to the English National Health Service expanded patient choice and encouraged hospitals to compete within a market with fixed prices. This study investigates whether these reforms led to improvements in hospital quality. We use a difference-in-difference-style estimator to test whether hospital quality (measured using mortality from acute myocardial infarction) improv...
متن کاملDoes Hospital Competition Improve Efficiency? An Analysis of the Recent Market-Based Reforms to the English NHS
This paper uses a difference-in-difference estimator to test whether the introduction of patient choice and hospital competition in the English NHS in January 2006 has prompted hospitals to become more efficient. Efficiency was measured using hospitals’ average length of stay (LOS) for patients undergoing elective hip replacement. LOS was broken down into its two key components: the time from a...
متن کاملDoes competition between hospitals improve clinical quality? A review of evidence from two eras of competition in the English NHS.
The health secretary, Andrew Lansley, has proposed changes to the English National Health Service (NHS) that will extend the hospital market introduced by “New Labour” in the 2000s. 2 This was the second era of hospital competition within the NHS; the first, the “internal market,” applied throughout the UK from 1991 to 1997. Studies of the NHS markets have generally used one of two paradigms, e...
متن کاملInterregional Patient Mobility in the Italian NHS: A Case of Badly-Managed Decentralization; Comment on “Regional Incentives and Patient Cross-Border Mobility: Evidence From the Italian Experience”
The article by Brenna and Spandonaro on interregional mobility for acute hospital care in Italy raises important issues concerning social and territorial equity in a healthcare system. Based on Regions and private providers’ strategic behavior, the hypothesis adopted to explain patient cross-border mobility (CBM), demonstrated by statistical analysis, may be further explored using qualitative m...
متن کاملWhen politics and markets collide: reforming the English National Health Service
Reforms to the English national health service (NHS) are using patient choice and provider competition to drive improvements in performance. In completing the design of the reforms, the government faces the challenge of ensuring that commissioners can negotiate on equal terms with providers, and that appropriate arrangements are put in place for market management and regulation. Politicians als...
متن کامل