Does hospital competition harm equity? Evidence from the English National Health Service

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Abstrakt

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.

OriginalsprogEngelsk
TidsskriftJournal of Health Economics
Vol/bind32
Udgave nummer2
Sider (fra-til)410-22
Antal sider13
ISSN0167-6296
DOI
StatusUdgivet - mar. 2013

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Copyright © 2012 Elsevier B.V. All rights reserved.

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