6533b861fe1ef96bd12c4f1d
RESEARCH PRODUCT
Does hospital competition harm equity? Evidence from the English National Health Service
Paolo Li DonniRichard CooksonMauro Laudicellasubject
InequalityNational Health Programsmedia_common.quotation_subjectNegative associationMarket structurePoverty AreasEconomicsHumansEconomics HospitalHealthcare Disparitieshealth care economics and organizationsmedia_commonEquity (economics)Market competitionEconomic CompetitionPublic economicsHealth PolicyPublic Health Environmental and Occupational HealthNational health serviceDifference in differencesHarmEnglandSocioeconomic FactorsSettore SECS-P/03 - Scienza Delle FinanzeSmall-Area AnalysisCompetition Hospital InequalityDemographic economicsRAdescription
Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market competition and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2011-10-01 |