Hospital competition and quality for non-emergency patients in the English NHS

Hugh Stanley Emrys Gravelle; Luigi Siciliani; Guiseppe Moscelli

Hospital competition and quality for non-emergency patients in the English NHS

Hugh Stanley Emrys Gravelle, Luigi Siciliani, Guiseppe Moscelli

Research output: Contribution to journal › Article › peer-review

Abstract

We investigate the effect on the quality of three high-volume non-emergency treatments of a reform that relaxed restrictions on patient choice of hospital. We employ a quasi difference-in difference strategy and use control functions to allow for time-varying patient selection into providers correlated with unobserved morbidity. After the reform, public hospitals facing more rivals reduced quality, increased waiting times, and reduced length of stay for hip and knee replacements. This is likely due to regulated prices implying larger losses on these treatments compared to coronary artery bypass grafts where no effects were found. Our findings are robust to estimation methods, competition measures, and allowing for entry of private providers.

Original language	English
Journal	RAND JOURNAL OF ECONOMICS
Publication status	Accepted/In press - 26 Oct 2020

Bibliographical note

This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

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elective_competition_2nd_revision_OCT2020
This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.
Accepted author manuscript, 1.81 MB

https://docs.google.com/document/d/1Eaen22VdZ3xUruAP9vNOr1gpnXR8wpCm1Pu8cLn0Qdo/edit?usp=sharing

Luigi Siciliani
- luigi.sicilianiyork.acuk
- Economics - Professor
Person: Academic

Cite this

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AB - We investigate the effect on the quality of three high-volume non-emergency treatments of a reform that relaxed restrictions on patient choice of hospital. We employ a quasi difference-in difference strategy and use control functions to allow for time-varying patient selection into providers correlated with unobserved morbidity. After the reform, public hospitals facing more rivals reduced quality, increased waiting times, and reduced length of stay for hip and knee replacements. This is likely due to regulated prices implying larger losses on these treatments compared to coronary artery bypass grafts where no effects were found. Our findings are robust to estimation methods, competition measures, and allowing for entry of private providers.

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JO - RAND JOURNAL OF ECONOMICS

JF - RAND JOURNAL OF ECONOMICS

ER -

Hospital competition and quality for non-emergency patients in the English NHS

Abstract

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Luigi Siciliani

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