The sorting effect in healthcare access: Those left behind

Carine Milcent

Economics & Human Biology, 2023, vol. 51, issue C

Abstract: Many governments have sought to enhance patient choice in hospital by intensifying competitive pressure on hospital administrations that is expected to improve efficiency, quality, and innovation. However, there is mixed evidence on whether patients travel past their local hospitals to seek better quality care and whether higher-income patients are those most sensitive to respond to competitive pressures. Using detailed data from 17 million inpatient stays admitted in France during 2019, this paper explores patients’ choice of provider where for-profit, non-profit, research hospital and local hospitals are allowed to compete with each other. We estimate the extent to which deprivation gradient plays on patient’s choice of provider. We found that, in general, patients travel for their care, with just one-quarter of them going to the nearest hospital. In fact, the most vulnerable patients (i.e., those socio-economically deprived, and very aged) are mostly treated in local public hospitals with the lowest quality service level, and with large variability in quality as well, while those with less socio-economic deprivation seek care at higher-quality for-profit hospitals. Our counterfactual simulations show that admission to university hospitals attenuates existing inequalities. However, whether it delays the healthcare access sought by this population remains an open question.

Keywords: Deprivation; Ageing; Inequality; Patient choice; Demand for healthcare; Rural areas; Quality; Distance; Empirical referral hospital (search for similar items in EconPapers)
JEL-codes: D12 I11 I18 L1 L44 (search for similar items in EconPapers)
Date: 2023
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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Working Paper: The sorting effect in healthcare access: Those left behind (2023)
Working Paper: The sorting effect in healthcare access: Those left behind (2023)
Working Paper: The sorting effect in healthcare access: Those left behind (2023)
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Persistent link: https://EconPapers.repec.org/RePEc:eee:ehbiol:v:51:y:2023:i:c:s1570677x23000631

DOI: 10.1016/j.ehb.2023.101282

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