Abstract
In many health care systems generalist physicians act as gatekeepers to secondary care. Under the English fundholding scheme from 1991/1992 to 1998/1999 general practices could elect to be given a budget to meet the costs of certain types of elective surgery (chargeable electives) for their patients and could retain any surplus. They did not pay for non-chargeable electives or for emergency admissions. Non-fundholding practices did not bear the cost of any type of hospital admissions. Fundholding is to be reintroduced from April 2005.
We estimate the effect of fundholding using a differences in differences methodology on a large 4-year panel of English general practices before and after the abolition of fundholding. The abolition of fundholding increased ex-fundholders' admission rates for chargeable elective admissions by between 3.5 and 5.1%. The effect on the early wave fundholders was greater (around 8%) than on later wave fundholders. We also use differences in differences for two types of admissions (non-chargeable electives, emergencies) not covered by fundholding as additional controls for unobserved temporal factors. These differences in differences in differences estimates suggest that the abolition of fundholding increased ex-fundholders' chargeable elective admissions by 4.9% (using the non-chargeables DID) and by 3.5% (using the emergencies DID). (c) 2005 Elsevier B.V. All rights reserved.
| Original language | English |
|---|---|
| Pages (from-to) | 449-478 |
| Number of pages | 30 |
| Journal | Journal of health economics |
| Volume | 25 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - May 2006 |
Keywords
- budgets
- health care
- gatekeeping
- fundholding
- admission rates
- NATIONAL-HEALTH-SERVICE
- SELECTION BIAS
- CARE PHYSICIANS
- UNITED-KINGDOM
- WAITING-TIMES
- NHS
- DEMAND
- IMPACT
- LISTS