Does competition from private surgical centres improve public hospitals’ performance? Evidence from the English National Health Service

Zack Cooper, Stephen Gibbons and Matthew Skellern

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

Abstract: This paper examines the impact of competition from government-facilitated entry of private, specialty surgical centres on the efficiency and case mix of incumbent public hospitals within the English NHS. We exploit the fact that the government chose the location of these surgical centres (Independent Sector Treatment Centres or ISTCs) based on nearby public hospitals’ waiting times – not length of stay or clinical quality – to construct treatment and control groups that are comparable with respect to key outcome variables of interest. Using a difference-in-difference estimation strategy, we find that ISTC entry led to greater efficiency – measured by presurgery length of stay for hip and knee replacements – at nearby public hospitals. However, these new entrants took on healthier patients and left incumbent hospitals treating patients who were sicker, and who stayed in hospital longer after surgery.

Keywords: Hospital Competition; Public-Private Competition; Market Entry; Market Structure; Outsourcing; Hospital Efficiency; Risk Selection; Cherry Picking (search for similar items in EconPapers)
JEL-codes: C23 H57 I11 L1 L33 R12 (search for similar items in EconPapers)
Pages: 51 pages
Date: 2016-06
New Economics Papers: this item is included in nep-com, nep-eff, nep-hea and nep-sog
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (11)

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http://eprints.lse.ac.uk/67662/ Open access version. (application/pdf)

Related works:
Journal Article: Does competition from private surgical centres improve public hospitals' performance? Evidence from the English National Health Service (2018)
Working Paper: Does competition from private surgical centres improve public hospitals’ performance? Evidence from the English National Health Service (2018)
Working Paper: Does competition from private surgical centres improve public hospitals' performance? Evidence from the English National Health Service (2016)
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Persistent link: https://EconPapers.repec.org/RePEc:ehl:lserod:67662

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