Trends in health care commissioning in the English NHS: an empirical analysis

TY - BOOK

T1 - Trends in health care commissioning in the English NHS: an empirical analysis

AU - Dusheiko, M.

AU - Goddard, M.

AU - Gravelle, H.

AU - Jacobs, R.

N1 - CHE RP11 © 2006 Mark Dusheiko, Maria Goddard, Hugh Gravelle, Rowena Jacobs. The full text of this report can be viewed free of charge from the Centre for Health Economics web site at: http://www.york.ac.uk/inst/che/pdf/rp11.pdf

PY - 2006/3

Y1 - 2006/3

N2 - In recent years there have been marked changes in organisational structures and budgetary arrangements in the English NHS, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and providers. Using data on elective hospital admissions from 1997/98 to 2002/03 we find that commissioning has become significantly more concentrated at PCO and GP level. There was a reduction in the average number of different providers used by PCOs (16.7 to 14.2), an increase in the average share of admissions accounted for by the main provider (49% to 69%), and an increase in the average Herfindahl index (0.35 to 0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations from 100 to 302. The rest was due to mergers amongst providers and the abolition of fundholding. GP fundholding practices which held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their primary care organisation. There was an increase in concentration of admissions for both types of GP practice but fundholders used more providers, had smaller shares at their main provider, and had smaller Herfindahl indices.

AB - In recent years there have been marked changes in organisational structures and budgetary arrangements in the English NHS, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and providers. Using data on elective hospital admissions from 1997/98 to 2002/03 we find that commissioning has become significantly more concentrated at PCO and GP level. There was a reduction in the average number of different providers used by PCOs (16.7 to 14.2), an increase in the average share of admissions accounted for by the main provider (49% to 69%), and an increase in the average Herfindahl index (0.35 to 0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations from 100 to 302. The rest was due to mergers amongst providers and the abolition of fundholding. GP fundholding practices which held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their primary care organisation. There was an increase in concentration of admissions for both types of GP practice but fundholders used more providers, had smaller shares at their main provider, and had smaller Herfindahl indices.

KW - concentration

KW - Herfindahl

KW - purchasing

KW - budgets

KW - elective admissions

M3 - Commissioned report

T3 - CHE Research Paper

BT - Trends in health care commissioning in the English NHS: an empirical analysis

PB - Centre for Health Economics, University of York

CY - York, UK

ER -