New joints: private providers and rising demand in the English National Health Service

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractThis paper investigates how changes in hospital choice sets aect levels of patient demand for elective hospital care. We exploit a set of reforms in England that opened up the market for publicly-funded patients to private hospitals. Impacts on demand are estimated using variation in distance to these private hospitals, within regions where supply constraints are xed. We nd that the reforms increased demand for publiclyfunded procedures. For public hospitals, volumes remained unchanged but waiting times fell. Taken together, our results provide new insights into how individuals make choices about their care and the scope of competition between hospitals.

Competition in health care: lessons from the English experience

“…There is also work on the impact of entry of new providers (e.g. Kelly and Stoye, 2015). And Farrar et al (2009) provide evidence on the effect of case-based payment.…”

“…It should be noted that patients choose on the basis of quality, as well as distance in England, when they select a health care provider. This includes choice of family doctors (Santos et al, 2017), provider of elective hip replacement surgery (Kelly and Stoye, 2015;Gutacker et al, 2016), and of open heart surgery. In some cases, this will reflect just the choices of patients, as of family doctors.…”

“…Whilst this may be true, there is a growing body of evidence from large scale studies using administrative data that treatment location has changed (e.g. Kelly and Tetlow, 2012 who study the role of private providers in the provision of elective care). It should be noted that patients choose on the basis of quality, as well as distance in England, when they select a health care provider.…”

“…5For example, in fiscal year 2010/2011, private hospital care accounted for around 17% of inpatient hip replacements (Kelly and Tetlow, 2012). …”

A systematic review of the accessibility, acceptability, safety, efficiency, clinical effectiveness and cost-effectiveness of private providers of elective surgical services compared with public providers

“…Access to health care is de ned as the extent to which nancial, organizational, geographical, and cultural barriers are minimized for patients 29 . Eleven papers from the UK, Australia, Denmark, Canada, Netherlands and Italy discussed the accessibility of services for cataract, hip, and knee patients and compared the private and public provision of these surgical procedures 3,6,9,10,12,13,21,[25][26][27][28] . Among these studies, only two 12,13 looked at accessibility related to patient preoperative/ general health status or symptom severity, and neither reached a de nite conclusion about the relevance of these factors.…”