title: Does hospital competition harm equity? Evidence from the English National Health Service.
abstract: 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.
authors: Centre for Health Economics, University of York, United Kingdom.
authors: Richard
authors: R
authors: Cookson
authors: Mauro
authors: M
authors: Laudicella
authors: Paolo
authors: P
authors: Li Donni
mesh_terms: D004465:Economic Competition; D004469:Economics, Hospital; D004739:England; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D009313:National Health Programs / Q000706:statistics & numerical data; D011204:Poverty Areas; D017062:Small-Area Analysis; D012959:Socioeconomic Factors