Working Paper: CEPR ID: DP4026
Authors: Simon Burgess; Denise Gossage; Carol Propper
Abstract: Payer-driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. We exploit differences in competition over time and space to identify the impact of competition. Using data on mortality as a measure of hospital quality and exploiting the policy change during the 1990s, we find that the relationship between competition and quality of care appears to be negative.
Keywords: competition; healthcare; mortality; quality of care
JEL Codes: H40; I10; L80
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Higher competition (L13) | Increased death rates from AMI (I12) |
| Competition (L13) | Negated improvements in quality due to technological advancements (L15) |
| Competition (L13) | Prioritization of cost-cutting over quality of care (H51) |
| Non-competitive hospitals (L39) | Control group for causal inference (C90) |