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Competition and Inequality: evidence from the English National Health Service 1991-2001

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Competition and Inequality : evidence from the English National Health Service 1991-2001. / Cookson, Richard; Dusheiko, Mark; Hardman, Geoffrey; Martin, Stephen.

In: JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY, Vol. 20, No. supplement 2, 07.2010, p. I181-I205.

Research output: Contribution to journalArticlepeer-review

Harvard

Cookson, R, Dusheiko, M, Hardman, G & Martin, S 2010, 'Competition and Inequality: evidence from the English National Health Service 1991-2001', JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY, vol. 20, no. supplement 2, pp. I181-I205. https://doi.org/10.1093/jopart/muq021

APA

Cookson, R., Dusheiko, M., Hardman, G., & Martin, S. (2010). Competition and Inequality: evidence from the English National Health Service 1991-2001. JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY, 20(supplement 2), I181-I205. https://doi.org/10.1093/jopart/muq021

Vancouver

Cookson R, Dusheiko M, Hardman G, Martin S. Competition and Inequality: evidence from the English National Health Service 1991-2001. JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY. 2010 Jul;20(supplement 2):I181-I205. https://doi.org/10.1093/jopart/muq021

Author

Cookson, Richard ; Dusheiko, Mark ; Hardman, Geoffrey ; Martin, Stephen. / Competition and Inequality : evidence from the English National Health Service 1991-2001. In: JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY. 2010 ; Vol. 20, No. supplement 2. pp. I181-I205.

Bibtex - Download

@article{89bcb7e88e4449178cd1c705ca0944f7,
title = "Competition and Inequality: evidence from the English National Health Service 1991-2001",
abstract = "Competition is often prescribed as an efficiency-enhancing tonic for ailing health systems. However, critics claim that competition exacerbates socioeconomic inequality in health care. This claim is tested in relation to the {"}internal market{"} reforms of the English National Health Service (NHS) from 1991 to 97, which injected a small dose of hospital competition into a state-funded, state-owned health system responsible for more than 90% of national health expenditure. Our dependent variables are NHS hospital utilization rates for hip replacement and heart revascularization in 8,500 English small areas from 1991 to 2001. We estimate small area level associations between deprivation and hospital utilization, allowing for need and supply variables. We then compare year-by-year inequality differences between areas with {"}potentially competitive{"} and {"}noncompetitive{"} local hospital markets, as competition was phased in and out. No evidence is found that competition had any effect on socioeconomic health care inequality.",
keywords = "NHS INTERNAL MARKET, CORONARY REVASCULARIZATION, REGULATED COMPETITION, SOCIOECONOMIC-STATUS, EMPIRICAL-ANALYSIS, JOINT REPLACEMENT, CARE SERVICES, WAITING-TIMES, MEDICAL-CARE, ACCESS",
author = "Richard Cookson and Mark Dusheiko and Geoffrey Hardman and Stephen Martin",
note = "{\textcopyright} The Author 2010. Published by Oxford University Press on behalf of the Journal of Public Administration Research and Theory, Inc. All rights reserved.",
year = "2010",
month = jul,
doi = "10.1093/jopart/muq021",
language = "English",
volume = "20",
pages = "I181--I205",
journal = "JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY",
issn = "1053-1858",
publisher = "Oxford University Press",
number = "supplement 2",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Competition and Inequality

T2 - evidence from the English National Health Service 1991-2001

AU - Cookson, Richard

AU - Dusheiko, Mark

AU - Hardman, Geoffrey

AU - Martin, Stephen

N1 - © The Author 2010. Published by Oxford University Press on behalf of the Journal of Public Administration Research and Theory, Inc. All rights reserved.

PY - 2010/7

Y1 - 2010/7

N2 - Competition is often prescribed as an efficiency-enhancing tonic for ailing health systems. However, critics claim that competition exacerbates socioeconomic inequality in health care. This claim is tested in relation to the "internal market" reforms of the English National Health Service (NHS) from 1991 to 97, which injected a small dose of hospital competition into a state-funded, state-owned health system responsible for more than 90% of national health expenditure. Our dependent variables are NHS hospital utilization rates for hip replacement and heart revascularization in 8,500 English small areas from 1991 to 2001. We estimate small area level associations between deprivation and hospital utilization, allowing for need and supply variables. We then compare year-by-year inequality differences between areas with "potentially competitive" and "noncompetitive" local hospital markets, as competition was phased in and out. No evidence is found that competition had any effect on socioeconomic health care inequality.

AB - Competition is often prescribed as an efficiency-enhancing tonic for ailing health systems. However, critics claim that competition exacerbates socioeconomic inequality in health care. This claim is tested in relation to the "internal market" reforms of the English National Health Service (NHS) from 1991 to 97, which injected a small dose of hospital competition into a state-funded, state-owned health system responsible for more than 90% of national health expenditure. Our dependent variables are NHS hospital utilization rates for hip replacement and heart revascularization in 8,500 English small areas from 1991 to 2001. We estimate small area level associations between deprivation and hospital utilization, allowing for need and supply variables. We then compare year-by-year inequality differences between areas with "potentially competitive" and "noncompetitive" local hospital markets, as competition was phased in and out. No evidence is found that competition had any effect on socioeconomic health care inequality.

KW - NHS INTERNAL MARKET

KW - CORONARY REVASCULARIZATION

KW - REGULATED COMPETITION

KW - SOCIOECONOMIC-STATUS

KW - EMPIRICAL-ANALYSIS

KW - JOINT REPLACEMENT

KW - CARE SERVICES

KW - WAITING-TIMES

KW - MEDICAL-CARE

KW - ACCESS

UR - http://www.scopus.com/inward/record.url?scp=77954367639&partnerID=8YFLogxK

U2 - 10.1093/jopart/muq021

DO - 10.1093/jopart/muq021

M3 - Article

VL - 20

SP - I181-I205

JO - JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY

JF - JOURNAL OF PUBLIC ADMINISTRATION RESEARCH AND THEORY

SN - 1053-1858

IS - supplement 2

ER -