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

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      Publication date Created:
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      Journal: American Economic Review
      Publisher: American Economic Association

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          Abstract

          <p class="first" id="d4716765e73">Choice in public services is controversial. We exploit a reform in the English National Health Service to assess the effect of removing constraints on patient choice. We estimate a demand model that explicitly captures the removal of the choice constraints imposed on patients. We find that, post-removal, patients became more responsive to clinical quality. This led to a modest reduction in mortality and a substantial increase in patient welfare. The elasticity of demand faced by hospitals increased substantially post- reform and we find evidence that hospitals responded to the enhanced incentives by improving quality. This suggests greater choice can raise quality. </p>

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          Is volume related to outcome in health care? A systematic review and methodologic critique of the literature.

          Ethan A. Halm, Clara Lee, Mark Chassin (2002)
          To systematically review the methodologic rigor of the research on volume and outcomes and to summarize the magnitude and significance of the association between them. The authors searched MEDLINE from January 1980 to December 2000 for English-language, population-based studies examining the independent relationship between hospital or physician volume and clinical outcomes. Bibliographies were reviewed to identify other articles of interest, and experts were contacted about missing or unpublished studies. Of 272 studies reviewed, 135 met inclusion criteria and covered 27 procedures and clinical conditions. Two investigators independently reviewed each article, using a standard form to abstract information on key study characteristics and results. The methodologic rigor of the primary studies varied. Few studies used clinical data for risk adjustment or examined effects of hospital and physician volume simultaneously. Overall, 71% of all studies of hospital volume and 69% of studies of physician volume reported statistically significant associations between higher volume and better outcomes. The strongest associations were found for AIDS treatment and for surgery on pancreatic cancer, esophageal cancer, abdominal aortic aneurysms, and pediatric cardiac problems (a median of 3.3 to 13 excess deaths per 100 cases were attributed to low volume). Although statistically significant, the volume-outcome relationship for coronary artery bypass surgery, coronary angioplasty, carotid endarterectomy, other cancer surgery, and orthopedic procedures was of much smaller magnitude. Hospital volume-outcome studies that performed risk adjustment by using clinical data were less likely to report significant associations than were studies that adjusted for risk by using administrative data. High volume is associated with better outcomes across a wide range of procedures and conditions, but the magnitude of the association varies greatly. The clinical and policy significance of these findings is complicated by the methodologic shortcomings of many studies. Differences in case mix and processes of care between high- and low-volume providers may explain part of the observed relationship between volume and outcome.
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            Applied Welfare Economics with Discrete Choice Models

            Kenneth Small, Harvey Rosen (1981)
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              Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms*

              Zack Cooper, Stephen Gibbons, Simon Jones … (2011)
              Recent substantive reforms to the English National Health Service expanded patient choice and encouraged hospitals to compete within a market with fixed prices. This study investigates whether these reforms led to improvements in hospital quality. We use a difference-in-difference-style estimator to test whether hospital quality (measured using mortality from acute myocardial infarction) improved more quickly in more competitive markets after these reforms came into force in 2006. We find that after the reforms were implemented, mortality fell (i.e. quality improved) for patients living in more competitive markets. Our results suggest that hospital competition can lead to improvements in hospital quality.
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                Author and article information

                Journal
                Title: American Economic Review
                Abbreviated Title: American Economic Review
                Publisher: American Economic Association
                ISSN (Print): 0002-8282
                Publication date Created: November 2016
                Publication date (Print): November 2016
                Volume: 106
                Issue: 11
                Pages: 3521-3557
                Article
                DOI: 10.1257/aer.20121532
                PubMed ID: 29553210
                SO-VID: 55840db0-6b65-4671-8197-2ec8dd58684c
                Copyright © © 2016
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