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Competition and Quality: Evidence from the NHS Internal Market 1991-1999

Author

Listed:
  • Simon Burgess
  • Denise Gossage
  • Carol Propper
Abstract
Payer-driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. We exploit differences in competition over time and space to identify the impact of competition. Using data on mortality as a measure of hospital quality and exploiting the policy change during the 1990s, we find that the relationship between competition and quality of care appears to be negative.

Suggested Citation

  • Simon Burgess & Denise Gossage & Carol Propper, 2003. "Competition and Quality: Evidence from the NHS Internal Market 1991-1999," The Centre for Market and Public Organisation 03/077, The Centre for Market and Public Organisation, University of Bristol, UK.
    • Handle: RePEc:bri:cmpowp:03/077
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    File URL: http://www.bris.ac.uk/Depts/CMPO/workingpapers/wp77.pdf
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    References listed on IDEAS

    as
    1. Dranove, David & White, William D, 1994. "Recent Theory and Evidence on Competition in Hospital Markets," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 3(1), pages 169-209, Spring.
    2. Propper, Carol & Burgess, Simon & Green, Katherine, 2004. "Does competition between hospitals improve the quality of care?: Hospital death rates and the NHS internal market," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1247-1272, July.
    3. repec:bla:jemstr:v:3:y:1994:i:1:p:169-209:a is not listed on IDEAS
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    Cited by:

    1. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    2. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    3. Olivella, Pau & Vera-Hernandez, Marcos, 2007. "Competition among differentiated health plans under adverse selection," Journal of Health Economics, Elsevier, vol. 26(2), pages 233-250, March.
    4. Siciliani, Luigi & Stanciole, Anderson & Jacobs, Rowena, 2009. "Do waiting times reduce hospital costs?," Journal of Health Economics, Elsevier, vol. 28(4), pages 771-780, July.

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    More about this item

    Keywords

    competition; health care; mortality; quality of care;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • L8 - Industrial Organization - - Industry Studies: Services
    • H4 - Public Economics - - Publicly Provided Goods

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