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

Article, Preprint English OPEN
Cookson, R. ; Laudicella, M. ; Li Donni, P. (2013)

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.
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    Noble M, mcLennan D, Wilkinson K, Whitworth A, Barnes H. 2008. Indices of Deprivation 2007. (Ed)^(Eds), Communities and Local Government Publications. Social Disadvantage Research Centre, University of Oxford: London; 2008.

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