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An empirical analysis of the impact of choice on waiting times

Siciliani, L. and Martin, S. (2007) An empirical analysis of the impact of choice on waiting times. Health Economics, 16 (18). pp. 763-779. ISSN 1057-9230

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Policy-makers often claim that enhancing patient choice induces more competition among hospitals and may therefore reduce waiting times. This paper tests this claim using 120 English NHS hospitals over the period 1999-2001. Several proxies for the degree of choice (or competition) are constructed including: (a) the number of hospitals within the catchment area of each hospital; (b) the number of hospitals in the catchment area of each hospital standardised by the population of the catchment area; (c) the inverse of the Herfindahl index (or the number of effective competitors). Several control variables are included: the availability of doctors, junior doctors, nurses, and other personnel; the availability of acute beds; the emergency admission rate; the day-case rate; the average length of inpatient stay; an indicator of case-mix; and mortality and re-admission rates. We find that more choice is significantly associated with lower waiting times at the sample mean (five hospitals) although the quantitative effect is modest: an extra hospital in a catchment area will only reduce waiting by at most a few days (or 1-2% reduction in waiting). There is also some evidence that increases in choice can boost waiting times when the degree of choice is very high (i.e. more than 11 hospitals are included in the catchment area).

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Economics and Related Studies (York)
Depositing User: York RAE Import
Date Deposited: 22 May 2009 15:35
Last Modified: 22 May 2009 15:35
Published Version: http://dx.doi.org/10.1002/hec.1205
Status: Published
Publisher: John Wiley & Sons
Identification Number: 10.1002/hec.1205
URI: http://eprints.whiterose.ac.uk/id/eprint/6247

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