Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service

Gaynor, Martin; Propper, Carol; Seiler, Stephan

doi:10.1257/aer.20121532

Cited by 153 publications

(125 citation statements)

References 45 publications

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“…Our analysis also relates to the literature investigating whether quality affects patient choice of hospital (e.g. Gaynor et al (2016) for coronary bypass, Gutacker et al (2016) and Beckert et al (2012) for hip replacement). Although quality is a key explanatory variable in models of choice of hospital and is the dependent variable in models of the effect of competition on quality, the literatures are complementary since competition can only affect quality if choice of hospital is affected by quality.…”

Section: Previous Literaturementioning

confidence: 99%

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Heterogeneous effects of patient choice and hospital competition on mortality

Moscelli¹,

Gravelle²,

Siciliani³

et al. 2018

Social Science & Medicine

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We examine whether the relaxation of constraints on patient choice of hospital in the English National Health Service in 2006 led to greater changes in mortality for hospitals which faced more rivals before the choice reform. We use patient level data from 2002 to 2010 for three high volume emergency conditions with high mortality risk: acute myocardial infarction (AMI) (288,279 patients), hip fracture (91,005 patients), stroke (214,103 patients). Since mortality risk varies by sub-diagnoses of AMI and stroke we include indicators for sub-diagnoses in the covariates. We also allow for the effect of covariates on mortality to differ before and after the 2006 choice reform. We find that the choice reform reduced mortality risk for hip fracture patients by 0.62% (95% CI: 1.22%, 0.01%), compared with the 2002/3-2010/11 mean of 3.5%, but had statistically insignificant negative effects for AMI and stroke. The reform also had heterogeneous effects across AMI and stroke sub-diagnoses, reducing mortality for 3% of AMI patients and 21% of stroke patients. The reduction in hip fracture mortality was greater for more deprived patients. Policies to increase competition and give patients greater choice are likely to have heterogeneous effects depending on details of patient case mix and market conditions.

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Section: Previous Literaturementioning

confidence: 99%

“…Since 2007, the NHS Choices website has provided public information on services and quality of providers. These policies led to changes in demand patterns and increased hospital elasticity of demand with respect to quality (Gaynor et al, 2016;Moscelli et al 2016b).…”

Section: Institutional Backgroundmentioning

confidence: 99%

Heterogeneous effects of patient choice and hospital competition on mortality

Moscelli¹,

Gravelle²,

Siciliani³

et al. 2018

Social Science & Medicine

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“…This includes the models in Goeree (2008), Gaynor, Propper, and Seiler (2016) and Manzini and Mariotti (2014). Under this 'Alternative-Specific Consideration' (ASC) approach, consideration set probabilities take the form:…”

Section: Identificationmentioning

confidence: 99%

What Do Consumers Consider Before They Choose? Identification from Asymmetric Demand Responses

Abaluck¹,

Adams‐Prassl²

2017

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Consideration set models relax the assumption that consumers are aware of all available options. Thus far, identification arguments for these models have relied either on auxiliary data on what options were considered or on instruments excluded from consideration or utility. In a discrete choice framework subsuming logit, probit and random coefficients models, we prove that utility and consideration set probabilities can be separately identified without these data intensive methods. In full-consideration models, choice probabilities satisfy a symmetry property analogous to Slutsky symmetry in continuous choice models. This symmetry breaks down in consideration set models when changes in characteristics perturb consideration, and we show that consideration probabilities are constructively identified from the resulting asymmetries. In a lab experiment, we recover preferences and consideration probabilities using only data on which items were ultimately chosen, and we apply the model to study hotel choices on Expedia.com and insurance choices in Medicare Part D.

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“…The quality of care can have large, and long-lasting, effects on the health of the consumer. Injecting greater competition into heavily regulated healthcare markets is a popular reform model in many jurisdictions (Gaynor et al 2016;Glied and Altman 2017;OECD 2012). But this takes place against the backdrop of a long-term trend of provider consolidation in healthcare markets (Gaynor and Town 2012;Fulton 2017).…”

Section: Introductionmentioning

confidence: 99%

Spatial competition and quality: Evidence from the English family doctor market

Gravelle

Dan

Propper

et al. 2019

Journal of Health Economics

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Background to series CHE Discussion Papers (DPs) began publication in 1983 as a means of making current research material more widely available to health economists and other potential users. So as to speed up the dissemination process, papers were originally published by CHE and distributed by post to a worldwide readership. The CHE Research Paper series takes over that function and provides access to current research output via web-based publication, although hard copy will continue to be available (but subject to charge).

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Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service

Cited by 153 publications

References 45 publications

Heterogeneous effects of patient choice and hospital competition on mortality

Heterogeneous effects of patient choice and hospital competition on mortality

What Do Consumers Consider Before They Choose? Identification from Asymmetric Demand Responses

Spatial competition and quality: Evidence from the English family doctor market

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