Divided by choice? For‐profit providers, patient choice and mechanisms of patient sorting in the English National Health Service

Abstract

This paper studies patient choice of provider following government reforms in the 2000s, which allowed for‐profit surgical centers to compete with existing public National Health Service (NHS) hospitals in England. For‐profit providers offer significant benefits, notably shorter waiting times. We estimate the extent to which different types of patients benefit from the reforms, and we investigate mechanisms that cause differential benefits. Our counterfactual simulations show that, in terms of the value of access, entry of for‐profit providers benefitted the richest patients twice as much as the poorest, and white patients six times as much as ethnic minority patients. Half of these differences is explained by healthcare geography and patient health, while primary care referral practice plays a lesser, though non‐negligible role. We also show that, with capitated reimbursement, different compositions of patient risks between for‐profit surgical centers and existing public hospitals put public hospitals at a competitive disadvantage.

Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatisation

“…We combined our random error simulation (figure 3) with a specification curve (appendix pp [16][17][18]. All possible specifications reported similar findings, with positive associations between outsourcing and treatable mortality.…”

“…The results from the covariate balancing models were robust to model specification, including full matching, choice of covariates, and removing any individual CCG from the data (see the appendix pp [14][15][16][17][18][19][20].…”

“…To account for potential bias in the main result from the choice of covariates in the model, we present a specification curve in the appendix that is combined with the random error loops (pp [16][17]. Finally, we sequentially dropped each CCG from our fixed-effects model to test whether any individual CCG was driving a substantial amount of the average effect size (appendix pp [14][15].…”

“…16 Another key dynamic is the different case-mixes often observed between for-profit and public providers-a result of so-called cream-skimming and concentrating the most complicated cases with public providers, which have no extra staff or funding to compensate. 17 However, evidence of the impact of so-called creeping privatisation in general, and in the NHS in England in particular, remains uncertain. In general, findings are often inconclusive in that they do not analyse the aggregate effect of outsourcing on service-wide performance.…”

Nurse allocation in hospital: hybridization of linear regression, fuzzy set and game-theoretic approaches

“…The authors [ 33 ] observed that the requirement of patient’s social support and community follow-up had significant influences on admission. Beckert et al [ 34 ] investigated the benefit of the public hospital in contrast to the private hospital and noticed that minority (who are relatively poor in terms of education and monetary standard) patients were getting less benefit due to geographical distribution. Kuklinski et al [ 35 ] observed that patients' choice of hospital depends upon the quality of treatment.…”