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Propper C, Burgess S and Green K, (2004)
‘Does Competition Between Hospitals Improve the Quality of Care? Hospital
Death Rates and the NHS Internal Market’
Journal of Public Economics, 88 (7-8): 1247-1272
- Examines the impact of competition (as introduced by the NHS Internal
Market reforms) on quality of care in NHS hospitals.
- Quality is measured
using the death rate from acute myocardial infarction (AMI).
- Uses data
from 1995-1998 to generate a cross-section dataset on AMI mortality,
generating a single data point for each hospital using its
weighted average
death rate over the 3 year period in order to reduce the ‘noise’ in
the data.
- A measure of competition is calculated which is based on
potential rather than actual patient
Key results:
- The estimated effect of competition is small and negative.
- Hospitals
in more competitive areas have higher death rates, controlling for
hospital characteristics, actual and potential patient characteristics.
- This is taken by the authors to suggest that weak quality signals
in the market have resulted in a weak cross-sectional association
between higher competition and lower quality.
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