Moving the quality needle? Provider choice, waiting times, and clinical outcomes

Joan Costa-Font and Juan David Garcia Corchero

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

Abstract: We examine the effect of the expansion of patient choice of health care provider on measures of process delivery and clinical outcomes central to the functioning of a health system, using a quasi-natural experiment in Spain over 2002–2019. We draw on a staggered adoption of provider choice reforms across Spanish regional health ser vices and a heterogeneity-robust difference-in-differences estimator applied to region year panel data alongside individual-level survey data. We estimate that the avail ability of provider choice reduced specialist waiting times by approximately 17 days (19% of the pre-reform mean) and the use of private specialist visits, without increasing public health spending. The waiting-time and private-utilisation results are robust to excluding the region where the 2009 reform bundled choice with new hospitals, public–private partnerships, and a budget increase. Although we cannot reject zero effects on some clinical outcomes, the evidence is consistent with the thesis that provider choice improves the “quality needle”, namely it improves observable process quality without affecting less-visible clinical dimensions.

Keywords: ARRAY(0x5b85f8365000) (search for similar items in EconPapers)
JEL-codes: D82 H75 I11 I18 (search for similar items in EconPapers)
Date: 2026-11-04
New Economics Papers: this item is included in nep-hea
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Published in Economica, 4, November, 2026. ISSN: 0013-0427

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