White Rose University Consortium logo
University of Leeds logo University of Sheffield logo York University logo

Trends in health care commissioning in the English NHS: an empirical analysis

Dusheiko, M., Goddard, M., Gravelle, H. and Jacobs, R. (2006) Trends in health care commissioning in the English NHS: an empirical analysis. Research Report. CHE Research Paper (11). Centre for Health Economics , York, UK.

Full text not available from this repository.


In recent years there have been marked changes in organisational structures and budgetary arrangements in the English NHS, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and providers. Using data on elective hospital admissions from 1997/98 to 2002/03 we find that commissioning has become significantly more concentrated at PCO and GP level. There was a reduction in the average number of different providers used by PCOs (16.7 to 14.2), an increase in the average share of admissions accounted for by the main provider (49% to 69%), and an increase in the average Herfindahl index (0.35 to 0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations from 100 to 302. The rest was due to mergers amongst providers and the abolition of fundholding. GP fundholding practices which held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their primary care organisation. There was an increase in concentration of admissions for both types of GP practice but fundholders used more providers, had smaller shares at their main provider, and had smaller Herfindahl indices.

Item Type: Monograph (Research Report)
Copyright, Publisher and Additional Information: © 2006 Mark Dusheiko, Maria Goddard, Hugh Gravelle, Rowena Jacobs. The full text of this report can be viewed free of charge from the Centre for Health Economics web site at: http://www.york.ac.uk/inst/che/pdf/rp11.pdf
Keywords: concentration, Herfindahl, purchasing, budgets, elective admissions
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
Depositing User: Repository Officer
Date Deposited: 24 Apr 2006
Last Modified: 04 Oct 2010 17:06
Published Version: http://www.york.ac.uk/inst/che/pdf/rp11.pdf
Status: Published
Publisher: Centre for Health Economics
Refereed: No
Related URLs:
URI: http://eprints.whiterose.ac.uk/id/eprint/1184

Actions (repository staff only: login required)