The effects of choice and competition on NHS performance
Lead Research Organisation:
University of York
Department Name: Social Policy Research Unit
Abstract
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Technical Summary
Aims and relevance of the study
Little evidence is available to support Labour‘s current attempts to re-introduce choice and competition into the NHS. The aim of my study is to gather rigorous quantitative evidence on the effects of these reforms on NHS performance (if any), including performance in tackling health inequalities, so that in five or ten years time policy makers are better able to make evidence-based decisions about the appropriate role of choice and competition in the NHS.
Objectives
1. To produce a comprehensive and up-to-date review of theory and evidence on the effects on all aspects of NHS performance of Conservative and Labour attempts to introduce choice and competition into the NHS
2. To perform quantitative analysis of the effects of Labour‘s attempts to introduce choice and competition into the NHS on aspects of NHS performance that are readily measurable using routine datasets, including performance in tackling health inequalities
Design and methodology
1. A preliminary review will be conducted at the start of the fellowship. This will examine theory and evidence on the effects of choice and competition on the performance of primary and secondary care providers in public, private and not-for-profit sectors, covering all aspects of performance including waiting times, quality of care, safety, cost-efficiency, productivity and inequalities of access and outcome. It will draw on theory from economics, organisational psychology, political science and other social sciences. It will summarise evidence from the UK internal market period, and from other OECD countries. The review will be updated towards the end of the fellowship, as further evidence becomes available.
2. Quantitative evidence will be gathered by analysing routine data using multiple regression techniques. The basic strategy will be to examine whether NHS performance in different geographical areas is related to the degree of choice and competition in those areas, controlling for other factors that may influence performance (such as population need, provider size, hospital foundation status, and other factors). Measures of the degree of choice and competition in each area will be constructed based on provider diversity, actual or potential patient flows, and other factors (e.g. location of patient choice pilots). Performance will be measured across a number of dimensions measurable using routine datasets, including waiting times, quality of care, productivity and performance in tackling health inequalities. The design of the study will be tailored to the available data, and to avoid duplicating other ongoing work.
Little evidence is available to support Labour‘s current attempts to re-introduce choice and competition into the NHS. The aim of my study is to gather rigorous quantitative evidence on the effects of these reforms on NHS performance (if any), including performance in tackling health inequalities, so that in five or ten years time policy makers are better able to make evidence-based decisions about the appropriate role of choice and competition in the NHS.
Objectives
1. To produce a comprehensive and up-to-date review of theory and evidence on the effects on all aspects of NHS performance of Conservative and Labour attempts to introduce choice and competition into the NHS
2. To perform quantitative analysis of the effects of Labour‘s attempts to introduce choice and competition into the NHS on aspects of NHS performance that are readily measurable using routine datasets, including performance in tackling health inequalities
Design and methodology
1. A preliminary review will be conducted at the start of the fellowship. This will examine theory and evidence on the effects of choice and competition on the performance of primary and secondary care providers in public, private and not-for-profit sectors, covering all aspects of performance including waiting times, quality of care, safety, cost-efficiency, productivity and inequalities of access and outcome. It will draw on theory from economics, organisational psychology, political science and other social sciences. It will summarise evidence from the UK internal market period, and from other OECD countries. The review will be updated towards the end of the fellowship, as further evidence becomes available.
2. Quantitative evidence will be gathered by analysing routine data using multiple regression techniques. The basic strategy will be to examine whether NHS performance in different geographical areas is related to the degree of choice and competition in those areas, controlling for other factors that may influence performance (such as population need, provider size, hospital foundation status, and other factors). Measures of the degree of choice and competition in each area will be constructed based on provider diversity, actual or potential patient flows, and other factors (e.g. location of patient choice pilots). Performance will be measured across a number of dimensions measurable using routine datasets, including waiting times, quality of care, productivity and performance in tackling health inequalities. The design of the study will be tailored to the available data, and to avoid duplicating other ongoing work.