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Heterogeneous effects of patient choice and hospital competition on mortality

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Heterogeneous effects of patient choice and hospital competition on mortality. / Moscelli, Giuseppe; Gravelle, Hugh; Siciliani, Luigi; Santos, Rita.

In: Social science and medicine, Vol. 216, 11.2018, p. 50-58.

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Harvard

Moscelli, G, Gravelle, H, Siciliani, L & Santos, R 2018, 'Heterogeneous effects of patient choice and hospital competition on mortality', Social science and medicine, vol. 216, pp. 50-58. https://doi.org/10.1016/j.socscimed.2018.09.009

APA

Moscelli, G., Gravelle, H., Siciliani, L., & Santos, R. (2018). Heterogeneous effects of patient choice and hospital competition on mortality. Social science and medicine, 216, 50-58. https://doi.org/10.1016/j.socscimed.2018.09.009

Vancouver

Moscelli G, Gravelle H, Siciliani L, Santos R. Heterogeneous effects of patient choice and hospital competition on mortality. Social science and medicine. 2018 Nov;216:50-58. https://doi.org/10.1016/j.socscimed.2018.09.009

Author

Moscelli, Giuseppe ; Gravelle, Hugh ; Siciliani, Luigi ; Santos, Rita. / Heterogeneous effects of patient choice and hospital competition on mortality. In: Social science and medicine. 2018 ; Vol. 216. pp. 50-58.

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@article{07e83a267fdb4cdbbd3ebb42436b7224,
title = "Heterogeneous effects of patient choice and hospital competition on mortality",
abstract = "We examine whether the relaxation of constraints on patient choice of hospital in the English National Health Service in 2006 led to greater changes in mortality for hospitals which faced more rivals before the choice reform. We use patient level data from 2002 to 2010 for three high volume emergency conditions with high mortality risk: acute myocardial infarction (AMI) (288,279 patients), hip fracture (91,005 patients), stroke (214,103 patients). Since mortality risk varies by sub-diagnoses of AMI and stroke we include indicators for sub-diagnoses in the covariates. We also allow for the effect of covariates on mortality to differ before and after the 2006 choice reform. We find that the choice reform reduced mortality risk for hip fracture patients by 0.62{\%} (95{\%} CI: 1.22{\%}, 0.01{\%}), compared with the 2002/3–2010/11 mean of 3.5{\%}, but had statistically insignificant negative effects for AMI and stroke. The reform also had heterogeneous effects across AMI and stroke sub-diagnoses, reducing mortality for 3{\%} of AMI patients and 21{\%} of stroke patients. The reduction in hip fracture mortality was greater for more deprived patients. Policies to increase competition and give patients greater choice are likely to have heterogeneous effects depending on details of patient case mix and market conditions.",
keywords = "Choice, Competition, England, Hospital, Mortality, Quality",
author = "Giuseppe Moscelli and Hugh Gravelle and Luigi Siciliani and Rita Santos",
note = "{\circledC} 2018 Elsevier Ltd. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.",
year = "2018",
month = "11",
doi = "10.1016/j.socscimed.2018.09.009",
language = "English",
volume = "216",
pages = "50--58",
journal = "Social Science & Medicine",
issn = "0277-9536",
publisher = "Elsevier Limited",

}

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TY - JOUR

T1 - Heterogeneous effects of patient choice and hospital competition on mortality

AU - Moscelli, Giuseppe

AU - Gravelle, Hugh

AU - Siciliani, Luigi

AU - Santos, Rita

N1 - © 2018 Elsevier Ltd. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

PY - 2018/11

Y1 - 2018/11

N2 - We examine whether the relaxation of constraints on patient choice of hospital in the English National Health Service in 2006 led to greater changes in mortality for hospitals which faced more rivals before the choice reform. We use patient level data from 2002 to 2010 for three high volume emergency conditions with high mortality risk: acute myocardial infarction (AMI) (288,279 patients), hip fracture (91,005 patients), stroke (214,103 patients). Since mortality risk varies by sub-diagnoses of AMI and stroke we include indicators for sub-diagnoses in the covariates. We also allow for the effect of covariates on mortality to differ before and after the 2006 choice reform. We find that the choice reform reduced mortality risk for hip fracture patients by 0.62% (95% CI: 1.22%, 0.01%), compared with the 2002/3–2010/11 mean of 3.5%, but had statistically insignificant negative effects for AMI and stroke. The reform also had heterogeneous effects across AMI and stroke sub-diagnoses, reducing mortality for 3% of AMI patients and 21% of stroke patients. The reduction in hip fracture mortality was greater for more deprived patients. Policies to increase competition and give patients greater choice are likely to have heterogeneous effects depending on details of patient case mix and market conditions.

AB - We examine whether the relaxation of constraints on patient choice of hospital in the English National Health Service in 2006 led to greater changes in mortality for hospitals which faced more rivals before the choice reform. We use patient level data from 2002 to 2010 for three high volume emergency conditions with high mortality risk: acute myocardial infarction (AMI) (288,279 patients), hip fracture (91,005 patients), stroke (214,103 patients). Since mortality risk varies by sub-diagnoses of AMI and stroke we include indicators for sub-diagnoses in the covariates. We also allow for the effect of covariates on mortality to differ before and after the 2006 choice reform. We find that the choice reform reduced mortality risk for hip fracture patients by 0.62% (95% CI: 1.22%, 0.01%), compared with the 2002/3–2010/11 mean of 3.5%, but had statistically insignificant negative effects for AMI and stroke. The reform also had heterogeneous effects across AMI and stroke sub-diagnoses, reducing mortality for 3% of AMI patients and 21% of stroke patients. The reduction in hip fracture mortality was greater for more deprived patients. Policies to increase competition and give patients greater choice are likely to have heterogeneous effects depending on details of patient case mix and market conditions.

KW - Choice

KW - Competition

KW - England

KW - Hospital

KW - Mortality

KW - Quality

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U2 - 10.1016/j.socscimed.2018.09.009

DO - 10.1016/j.socscimed.2018.09.009

M3 - Article

VL - 216

SP - 50

EP - 58

JO - Social Science & Medicine

T2 - Social Science & Medicine

JF - Social Science & Medicine

SN - 0277-9536

ER -