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

Paolo Li Donni, Mauro Laudicella, Richard Cookson

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

Abstract

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
Original languageEnglish
Pages (from-to)410-422
Number of pages12
JournalJournal of Health Economics
Volume32
Publication statusPublished - 2013

All Science Journal Classification (ASJC) codes

  • Health Policy
  • Public Health, Environmental and Occupational Health

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