Market structure, patient choice and hospital quality for elective patients

Giuseppe Moscelli; Hugh Stanley Emrys Gravelle; Luigi Siciliani

Market structure, patient choice and hospital quality for elective patients

Giuseppe Moscelli, Hugh Stanley Emrys Gravelle, Luigi Siciliani

Research output: Working paper › Discussion paper

Abstract

We examine the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England. We allow for time-varying endogeneity due to the effect of unobserved patient characteristics on patient choice of hospital using Two Stage
Residual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix.

Original language	English
Place of Publication	York, UK
Publisher	Centre for Health Economics, University of York
Pages	1-33
Number of pages	33
Publication status	Published - Nov 2016

Publication series

Name	CHE Research Paper
Publisher	Centre for Health Economics, University of York
No.	139

Keywords

competition
quality
hospital, choice
electives

Access to Document

CHERP139_market_structure_patient_choice_hospital_qualityFinal published version, 1.99 MB

https://www.york.ac.uk/media/che/documents/papers/researchpapers/CHERP139_market_structure_patient_choice_hospital_quality.pdf

Cite this

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title = "Market structure, patient choice and hospital quality for elective patients",

abstract = "We examine the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England. We allow for time-varying endogeneity due to the effect of unobserved patient characteristics on patient choice of hospital using Two StageResidual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix.",

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AU - Gravelle, Hugh Stanley Emrys

AU - Siciliani, Luigi

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N2 - We examine the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England. We allow for time-varying endogeneity due to the effect of unobserved patient characteristics on patient choice of hospital using Two StageResidual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix.

AB - We examine the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England. We allow for time-varying endogeneity due to the effect of unobserved patient characteristics on patient choice of hospital using Two StageResidual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix.

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