Söderlund N, Csaba I, Gray A, Milne R and Raftery J, (1997)

‘Impact of the NHS Reforms on English Hospital Productivity:
an Analysis of the First Three Years’

British Medical Journal, 315: 1126-1129

• Evaluates the effect of purchaser mix, market competition, and trust status on hospital productivity within the NHS internal market.
• Uses panel data on cost and activity taken from Hospital Episodes Statistics and Hospital Financial Returns, for 510 acute hospitals in England for 1991-2 to 1993-4.

Key results:

• Gaining trust status and increasing host district purchaser share were associated with productivity increases after adjustment for casemix, regional salary differences, and hospital size.
• Hospitals that became trusts during the study period were on average less productive at the beginning of the period than those that did not, and there were no significant productivity differences between trust waves at the end of the period in 1993-94.
• Market concentration was not associated with productivity differences.
• Note, however, that the authors cannot measure quality, and so assume it is relatively constant across hospitals over time.

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