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Dohmen P, van Ineveld M, Markus A, van der Hagen L, van de Klundert J. Does competition improve hospital performance: a DEA based evaluation from the Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022:1-19. [PMID: 36192512 PMCID: PMC9529606 DOI: 10.1007/s10198-022-01529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
Many countries have introduced competition among hospitals aiming to improve their performance. We evaluate the introduction of competition among hospitals in the Netherlands over the years 2008-2015. The analysis is based on a unique longitudinal data set covering all Dutch hospitals and health insurers, as well as demographic and geographic data. We measure hospital performance using Data Envelopment Analysis and distinguish three components of competition: the fraction of freely negotiated services, market power of hospitals, and insurer bargaining power. We present new methods to define variables for each of these components which are more accurate than previously developed measures. In a multivariate regression analysis, the variables explain more than half of the variance in hospital efficiency. The results indicate that competition between hospitals and the relative fraction of freely negotiable health services are positively related to hospital efficiency. At the same time, the policy measure to steadily increase the fraction of health services contracted in competition may well have resulted in a decrease in hospital efficiency. The models show no significant association between insurer bargaining power and hospital efficiency. Altogether, the results offer little evidence that the introduction of competition for hospital care in the Netherlands has been effective.
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Affiliation(s)
- Peter Dohmen
- Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands.
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
- Dutch Healthcare Authority (Nederlandse Zorgautoriteit; NZa), Utrecht, The Netherlands.
| | - Martin van Ineveld
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Aniek Markus
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Liana van der Hagen
- Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands
| | - Joris van de Klundert
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
- School of Business, Universidad Adolfo Ibanez, Santiago de Chile, Chile
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van der Schors W, Kemp R, van Hoeve J, Tjan-Heijnen V, Maduro J, Vrancken Peeters MJ, Siesling S, Varkevisser M. Associations of hospital volume and hospital competition with short-term, middle-term and long-term patient outcomes after breast cancer surgery: a retrospective population-based study. BMJ Open 2022; 12:e057301. [PMID: 35473746 PMCID: PMC9045096 DOI: 10.1136/bmjopen-2021-057301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES For oncological care, there is a clear tendency towards centralisation and collaboration aimed at improving patient outcomes. However, in market-based healthcare systems, this trend is related to the potential trade-off between hospital volume and hospital competition. We analyse the association between hospital volume, competition from neighbouring hospitals and outcomes for patients who underwent surgery for invasive breast cancer (IBC). OUTCOME MEASURES Surgical margins, 90 days re-excision, overall survival. DESIGN, SETTING, PARTICIPANTS In this population-based study, we use data from the Netherlands Cancer Registry. Our study sample consists of 136 958 patients who underwent surgery for IBC between 2004 and 2014 in the Netherlands. RESULTS Our findings show that treatment types as well as patient and tumour characteristics explain most of the variation in all outcomes. After adjusting for confounding variables and intrahospital correlation in multivariate logistic regressions, hospital volume and competition from neighbouring hospitals did not show significant associations with surgical margins and re-excision rates. For patients who underwent surgery in hospitals annually performing 250 surgeries or more, multilevel Cox proportional hazard models show that survival was somewhat higher (HR 0.94). Survival in hospitals with four or more (potential) competitors within 30 km was slightly higher (HR 0.97). However, this effect did not hold after changing this proxy for hospital competition. CONCLUSIONS Based on the selection of patient outcomes, hospital volume and regional competition appear to play only a limited role in the explanation of variation in IBC outcomes across Dutch hospitals. Further research into hospital variation for high-volume tumours like the one studied here is recommended to (i) use consistently measured quality indicators that better reflect multidisciplinary clinical practice and patient and provider decision-making, (ii) include more sophisticated measures for hospital competition and (iii) assess the entire process of care within the hospital, as well as care provided by other providers in cancer networks.
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Affiliation(s)
- Wouter van der Schors
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ron Kemp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Dutch Authority for Consumers & Markets, The Hague, The Netherlands
| | - Jolanda van Hoeve
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | - John Maduro
- Radiotherapy, UMCG, Groningen, The Netherlands
| | - Marie-Jeanne Vrancken Peeters
- Department of surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, Universiteit Twente, Enschede, The Netherlands
| | - Marco Varkevisser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Cho HA, Kim BR, Shin H. Travel Time for Dental Care Services Based on Patient Preference in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042051. [PMID: 35206239 PMCID: PMC8872074 DOI: 10.3390/ijerph19042051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022]
Abstract
This study analyzed patient preferences using travel time from residence to dental institution when selecting dental care services. We used data from the Korean Health Panel from 2008 to 2017 and analyzed each dental service episode. Since the distribution of travel time was skewed to the left, median travel time was analyzed. The association of travel time with services was analyzed via the population-averaged generalized estimating equation (GEE) with the Poisson family. The median of the average travel time per episode was longer for non-National Health Insurance (NHI)-covered services and shorter for NHI-covered services. The first quintile of low-income subjects traveled the longest for all services and utilized dental care the most. In the GEE analysis, travel time was approximately three times longer for implant treatment and gold inlay/resin fillings and >2 times longer for orthodontic care than for NHI-covered services. Patients residing in rural counties traveled for longer than residents of large cities. Income was statistically significant; however, the coefficient was close to zero. Travel time was related to the type of service and reflected patient preference. This was more prominent for expensive non-NHI-covered services than for NHI-covered services. The findings suggest patients’ subjective preferences for dental clinic selection are expressed as rational deliberation considering each individual’s situation.
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Affiliation(s)
- Han-A Cho
- Department of Dental Hygiene, Shinhan University, 95, Hoam-ro, Uijeongbu-si 11644, Korea;
| | - Bo-Ra Kim
- Department of Dental Hygiene, Namseoul University, 91, Cheonan-si 31020, Korea;
| | - Hosung Shin
- Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, 460, Iksan-daero, Iksan-si 54538, Korea
- Correspondence: ; Tel.: +82-63-850-6915; Fax: +82-63-850-6934
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Oladimeji AO, Adewole DA, Adeniji F. The bypassing of healthcare facilities among National Health Insurance Scheme enrollees in Ibadan, Nigeria. Int Health 2021; 13:291-296. [PMID: 32986116 PMCID: PMC8079309 DOI: 10.1093/inthealth/ihaa063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/18/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bypassing occurs when patients knowingly visit a health facility other than the one they live nearest to. In Ibadan, southwest Nigeria, the majority of enrollees in the National Health Insurance Scheme (NHIS) receive medical care in just 12% of the available NHIS-accredited facilities. Given that enrollees access healthcare services at highly subsidized rates under the scheme, this study aimed to determine the factors responsible for the observed distribution of enrollees across these health facilities. METHODS The study was a descriptive cross-sectional survey conducted among NHIS enrollees receiving care at outpatient departments of five randomly selected accredited health facilities in Ibadan. A total of 311 NHIS enrollees were consecutively recruited and a semistructured, pretested, interviewer-administered questionnaire was used to elicit information from respondents. Descriptive and inferential statistics were used to present results at 5% level of significance. Distance traveled by patients from their residence to the facilities was measured using Google maps. RESULTS The mean age of respondents was 37.1±16.1 y. There were 167 (53.7%) males and 224 (72.3%) were married. The bypassing rate was 174 (55.3%). More than a third of enrollees, 127 (41.0%), reported that their hospital choice was made based on physician referral, 130 (41.8%) based on personal choice, 26 (8.4%) based upon the recommendation of the Health Management Organization (HMO), while 27 (8.7%) were influenced by friends/family/colleagues. Bypassing was positively associated with educational status (X2 = 13.147, p=0.004). Respondents who bypassed expended additional time and money traveling to the farther away hospitals, 35.1 (±34.66) min and 389.51 (±545.21) naira per visit, respectively. CONCLUSION The level of bypassing among enrollees was fairly high. Enrollees should be properly guided regarding the need to access healthcare in facilities closer to them by their HMOs and physicians in the case of referrals. This will reduce bypassing and the cost of travel leading to better outcomes among enrollees.
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Affiliation(s)
- Adetola O Oladimeji
- Department of Health Policy and Management, Faculty of Public Health, University of Ibadan, Nigeria
| | - David A Adewole
- Department of Health Policy and Management, Faculty of Public Health, University of Ibadan, Nigeria
| | - Folashayo Adeniji
- Department of Health Policy and Management, Faculty of Public Health, University of Ibadan, Nigeria
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Roos AF, O'Donnell O, Schut FT, Van Doorslaer E, Van Gestel R, Varkevisser M. Does price deregulation in a competitive hospital market damage quality? JOURNAL OF HEALTH ECONOMICS 2020; 72:102328. [PMID: 32599157 DOI: 10.1016/j.jhealeco.2020.102328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
Regulators may be hesitant to permit price competition in healthcare markets because of its potential to damage quality. We assess whether this fear is well founded by examining a reform that permitted Dutch health insurers to freely negotiate prices with hospitals. Unlike previous research on hospital competition that has relied on quality indicators for urgent treatments, we take advantage of a plausible absence of selection bias to identify the effect on the quality of elective procedures that should be more price responsive. Using data on all admissions for hip replacements to Dutch hospitals and a difference-in-differences comparison between more and less concentrated markets, we find no evidence that price deregulation in a competitive environment reduces quality measured by hip replacement readmission rates.
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Affiliation(s)
- Anne-Fleur Roos
- Netherlands Bureau of Economic Policy Analysis (CPB) & Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam (EUR), Netherlands.
| | - Owen O'Donnell
- Erasmus School of Economics (ESE) & ESHPM, EUR, Tinbergen Institute (TI), Netherlands.
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Pitkänen V, Jauhiainen S, Linnosmaa I. Low risk, high reward? Repeated competitive biddings with multiple winners in health care. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:483-500. [PMID: 31902025 PMCID: PMC7214509 DOI: 10.1007/s10198-019-01143-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
We study physiotherapy providers' prices in repeated competitive biddings where multiple providers are accepted in geographical districts. Historically, only very few districts have rejected any providers. We show that this practice increased prices and analyze the effects the risk of rejection has on prices. Our data are derived from three subsequent competitive biddings. The results show that rejecting at least one provider decreased prices by more than 5% in the next procurement round. The results also indicate that providers have learned to calculate their optimal bids, which has also increased prices. Further, we perform counterfactual policy analysis of a capacity-rule of acceptance. The analysis shows that implementing a systematic acceptance rule results in a trade-off between direct cost savings and service continuity at patients' usual providers.
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Affiliation(s)
- Visa Pitkänen
- Research Department, Social Insurance Institution of Finland, P.O. Box 450, 00056, Helsinki, Finland.
| | - Signe Jauhiainen
- Research Department, Social Insurance Institution of Finland, P.O. Box 450, 00056, Helsinki, Finland
| | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Centre for Health and Social Economics, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
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Aggarwal A, van der Geest SA, Lewis D, van der Meulen J, Varkevisser M. Simulating the impact of centralization of prostate cancer surgery services on travel burden and equity in the English National Health Service: A national population based model for health service re-design. Cancer Med 2020; 9:4175-4184. [PMID: 32329227 PMCID: PMC7300407 DOI: 10.1002/cam4.3073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction There is limited evidence on the impact of centralization of cancer treatment services on patient travel burden and access to treatment. Using prostate cancer surgery as an example, this national study analysis aims to simulate the effect of different centralization scenarios on the number of center closures, patient travel times, and equity in access. Methods We used patient‐level data on all men (n = 19,256) undergoing radical prostatectomy in the English National Health Service between January 1, 2010 and December 31, 2014, and considered three scenarios for centralization of prostate cancer surgery services A: procedure volume, B: availability of specialized services, and C: optimization of capacity. The probability of patients travelling to each of the remaining centers in the choice set was predicted using a conditional logit model, based on preferences revealed through actual hospital selections. Multivariable linear regression analysed the impact on travel time according to patient characteristics. Results Scenarios A, B, and C resulted in the closure of 28, 24, and 37 of the 65 radical prostatectomy centers, respectively, affecting 3993 (21%), 5763 (30%), and 7896 (41%) of the men in the study. Despite similar numbers of center closures the expected average increase on travel time was very different for scenario B (+15 minutes) and A (+28 minutes). A distance minimization approach, assigning patients to their next nearest center, with patient preferences not considered, estimated a lower impact on travel burden in all scenarios. The additional travel burden on older, sicker, less affluent patients was evident, but where significant, the absolute difference was very small. Conclusion The study provides an innovative simulation approach using national patient‐level datasets, patient preferences based on actual hospital selections, and personal characteristics to inform health service planning. With this approach, we demonstrated for prostate cancer surgery that three different centralization scenarios would lead to similar number of center closures but to different increases in patient travel time, whilst all having a minimal impact on equity.
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Affiliation(s)
- Ajay Aggarwal
- Department of Cancer Epidemiology, Population and Global Health, King's College London, London, UK.,Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, UK
| | - Stéphanie A van der Geest
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Daniel Lewis
- Department of Social and Environment Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Marco Varkevisser
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lu TC, Angell B, Dunn H, Ford B, White A, Keay L. Determining patient preferences in a glaucoma service: A discrete choice experiment. Clin Exp Ophthalmol 2019; 47:1146-1155. [PMID: 31397968 DOI: 10.1111/ceo.13606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/14/2019] [Accepted: 08/03/2019] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Patient perspectives are crucial in informing design of acceptable services. BACKGROUND This study determined patient preferences in glaucoma care. DESIGN A discrete choice experiment was used to evaluate the relative importance of out-of-pocket costs, waiting time, continuity of care, service location and expertise. PARTICIPANTS Ninety-eight glaucoma suspects or glaucoma patients were recruited from one public and two private clinics in Sydney. METHODS Twelve choice-tasks were presented in random order and forced-choice preferences were elicited. Choice data were analysed using a multinominal logit model (NLOGIT 4.0). MAIN OUTCOME MEASURES The relative importance and the likelihood of choosing services with each attribute were determined. Willingness-to-pay and willingness-to-wait were calculated. Analyses were stratified by whether the patient attended a public or private glaucoma clinic and other demographic features. RESULTS Choice was influenced by four or five attributes: greater clinician expertise, the same clinician each visit, lower out-of-pocket costs and shorter wait times (all P < .05). Respondents were willing to pay an additional (Australian dollars) $325 (95% confidence interval [CI] 188-389) to see a senior eye doctor, and $87 (95% CI 60-116) to see the same clinician each visit. Respondents were willing to wait for these attributes; however, the estimates had wide confidence intervals and were beyond the range tested. Private patients had a stronger preference for expertise and continuity of care compared to public patients. CONCLUSIONS AND RELEVANCE Expertise and continuity of care were important to glaucoma patients in this setting, and they were willing to pay out-of-pocket and concede longer waiting times to secure these preferences.
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Affiliation(s)
- Thomas Chengxuan Lu
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.,Emergency Department, St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Blake Angell
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Hamish Dunn
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Belinda Ford
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew White
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lisa Keay
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
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van der Geest SA, Varkevisser M. Patient responsiveness to a differential deductible: empirical results from The Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:513-524. [PMID: 30539335 PMCID: PMC6517340 DOI: 10.1007/s10198-018-1014-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Health insurers may use financial incentives to encourage their enrollees to choose preferred providers for medical treatment. Empirical evidence whether differences in cost-sharing rates across providers affects patient choice behavior is, especially from Europe, limited. This paper examines the effect of a differential deductible to steer patient provider choice in a Dutch regional market for varicose veins treatment. Using individual patients' choice data and information about their out-of-pocket payments covering the year of the experiment and 1 year before, we estimate a conditional logit model that explicitly controls for pre-existing patient preferences. Our results suggest that in this natural experiment designating preferred providers and waiving the deductible for enrollees using these providers significantly influenced patient choice. The average cross-price elasticity of demand is found to be 0.02, indicating that patient responsiveness to the cost-sharing differential itself was low. Unlike fixed cost-sharing differences, the deductible exemption was conditional on the patient's other medical expenses occurring in the policy year. The differential deductible did, therefore, not result in a financial benefit for patients with annual costs exceeding their total deductible.
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Affiliation(s)
- Stéphanie A van der Geest
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Marco Varkevisser
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Isaksson D, Blomqvist P, Pingel R, Winblad U. Risk selection in primary care: a cross-sectional fixed effect analysis of Swedish individual data. BMJ Open 2018; 8:e020402. [PMID: 30355789 PMCID: PMC6224750 DOI: 10.1136/bmjopen-2017-020402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/29/2018] [Accepted: 08/22/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess socioeconomic differences between patients registered with private and public primary healthcare centres. DESIGN Population-based cross-sectional study controlling for municipality and household. SETTING Swedish population-based socioeconomic data collected from Statistics Sweden linked with individual registration data from all 21 Swedish regions. PARTICIPANTS All individuals residing in Sweden on 31 December 2015 (n=9 851 017) were included in the study. PRIMARY OUTCOME MEASURES Registration with private versus public primary healthcare centres. RESULTS After controlling for municipality and household, individuals with higher socioeconomic status were more likely to be registered with a private primary healthcare provider. Individuals in the highest income quantile were 4.9 percentage points (13.7%) more likely to be registered with a private primary healthcare provider compared with individuals in the lowest income quantile. Individuals with 1-3 years of higher education were 4.7 percentage points more likely to be registered with a private primary healthcare provider compared with those with an incomplete primary education. CONCLUSIONS The results show that there are notable differences in registration patterns, indicating a skewed distribution of patients and health risks between private and public primary healthcare providers. This suggests that risk selection behaviour occurs in the reformed Swedish primary healthcare system, foremost through location patterns.
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Affiliation(s)
- David Isaksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Paula Blomqvist
- Department of Governance, Uppsala University, Uppsala, Sweden
| | - Ronnie Pingel
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Saley I, Molinari N, Ribatet M. Comparing the spatial attractiveness of hospitals using zero-inflated spatial models. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2018. [DOI: 10.1007/s10742-018-0181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Bes RE, Curfs EC, Groenewegen PP, de Jong JD. Selective contracting and channelling patients to preferred providers: A scoping review. Health Policy 2017; 121:504-514. [PMID: 28381338 DOI: 10.1016/j.healthpol.2017.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 02/16/2017] [Accepted: 03/16/2017] [Indexed: 11/25/2022]
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Smith H, Currie C, Chaiwuttisak P, Kyprianou A. Patient choice modelling: how do patients choose their hospitals? Health Care Manag Sci 2017; 21:259-268. [PMID: 28401405 DOI: 10.1007/s10729-017-9399-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 02/08/2017] [Indexed: 11/24/2022]
Abstract
As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient's choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care. The Multinomial Logit model is successfully fitted to the data. Results obtained with the Utility Maximising Nested Logit model show that nesting according to city or town may be invalid for these data; in other words, the choice of hospital does not appear to be preceded by choice of city. In all of the analysis carried out, distance appears to be one of the main influences on a patient's choice of hospital rather than statistics available on the Internet.
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Health plan choice in the Netherlands: restrictive health plans preferred by young and healthy individuals. HEALTH ECONOMICS POLICY AND LAW 2017; 12:345-362. [PMID: 28290918 DOI: 10.1017/s1744133116000517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In a health care system based on managed competition, health insurers negotiate on quality and price with care providers and are allowed to offer restrictive health plans. It is crucial that enrolees who need care choose restrictive health plans, as otherwise health insurers cannot channel patients to contracted providers and they will lose their bargaining power in negotiations with providers. We aim to explain enrolees' choice of a restrictive health plan in exchange for a lower premium. In 2014 an online survey with an experimental design was conducted on members of an access panel (response 78%; n=3,417). Results showed 37.4% of respondents willing to choose a restrictive health plan in exchange for a lower premium. This fell to 22% when the restrictive health plan also included a longer travelling time. Enrolees who choose a restrictive health plan are younger and healthier, or on lower incomes, than those preferring a non-restrictive one. This means that enrolees who use care will be unlikely to choose a restrictive health plan and, therefore, health insurers will not be able to channel them to contracted care providers. This undermines the goals of the health care system based on managed competition.
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Gutacker N, Siciliani L, Moscelli G, Gravelle H. Choice of hospital: Which type of quality matters? JOURNAL OF HEALTH ECONOMICS 2016; 50:230-246. [PMID: 27590088 PMCID: PMC5138156 DOI: 10.1016/j.jhealeco.2016.08.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 06/27/2016] [Accepted: 08/16/2016] [Indexed: 05/25/2023]
Abstract
The implications of hospital quality competition depend on what type of quality affects choice of hospital. Previous studies of quality and choice of hospitals have used crude measures of quality such as mortality and readmission rates rather than measures of the health gain from specific treatments. We estimate multinomial logit models of hospital choice by patients undergoing hip replacement surgery in the English NHS to test whether hospital demand responds to quality as measured by detailed patient reports of health before and after hip replacement. We find that a one standard deviation increase in average health gain increases demand by up to 10%. The more traditional measures of hospital quality are less important in determining hospital choice.
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Affiliation(s)
- Nils Gutacker
- Centre for Health Economics, University of York, York, United Kingdom.
| | - Luigi Siciliani
- Department of Economics and Related Studies, University of York, York, United Kingdom
| | - Giuseppe Moscelli
- Centre for Health Economics, University of York, York, United Kingdom
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, United Kingdom
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Aggarwal A, Lewis D, Mason M, Sullivan R, van der Meulen J. Patient Mobility for Elective Secondary Health Care Services in Response to Patient Choice Policies: A Systematic Review. Med Care Res Rev 2016; 74:379-403. [PMID: 27357394 PMCID: PMC5502904 DOI: 10.1177/1077558716654631] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Our review establishes the empirical evidence for patient mobility for elective secondary care services in countries that allow patients to choose their health care provider. PubMed and Embase were searched for relevant articles between 1990 and 2015. Of 5,994 titles/abstracts reviewed, 26 studies were included. The studies used three main methodological models to establish mobility. Variation in the extent of patient mobility was observed across the studies. Mobility was positively associated with lower waiting times, indicators of better service quality, and access to advanced technology. It was negatively associated with advanced age or lower socioeconomic backgrounds. From a policy perspective we demonstrate that a significant proportion of patients are prepared to travel beyond their nearest provider for elective services. As a consequence, some providers are likely to be “winners” and others “losers,” which could result in overall decreased provider capacity or inefficient utilization of existing services. Equity also remains a key concern.
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Affiliation(s)
- Ajay Aggarwal
- 1 London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Lewis
- 1 London School of Hygiene and Tropical Medicine, London, UK
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Victoor A, Delnoij D, Friele R, Rademakers J. Why patients may not exercise their choice when referred for hospital care. An exploratory study based on interviews with patients. Health Expect 2016; 19:667-78. [PMID: 24938761 PMCID: PMC5055249 DOI: 10.1111/hex.12224] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Various north-western European health-care systems encourage patients to make an active choice of health-care provider. This study explores, qualitatively, patients' hospital selection processes and provides insight into the reasons why patients do or do not make active choices. METHODS Semi-structured individual interviews were conducted with 142 patients in two departments of three Dutch hospitals. Interviews were recorded, transcribed and analysed in accordance with the grounded theory approach. RESULTS Three levels of choice activation were identified - passive, semi-active and active. The majority of the patients, however, visited the default hospital without having used quality information or considered alternatives. Various factors relating to patient, provider and health-care system characteristics were identified that influenced patients' level of choice activation. On the whole, the patients interviewed could be classified into five types with regard to how they chose, or 'ended up at' a hospital. These types varied from patients who did not have a choice to patients who made an active choice. CONCLUSIONS A large variation exists in the way patients choose a hospital. However, most patients tend to visit the default without being concerned about choice. Generally, they do not see any reason to choose another hospital. In addition, barriers exist to making choices. The idea of a patient who actively makes a choice originates from neoclassical microeconomic theory. However, policy makers may try in vain to bring principles originating from this theory into health care. Even so, patients do value the opportunity of attending 'their' own hospital.
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Affiliation(s)
- Aafke Victoor
- Netherlands Institute for Health Services Research (NIVEL)Utrechtthe Netherlands
| | - Diana Delnoij
- Quality Institute of the National Health Care InstituteDiementhe Netherlands
- ‘Transparency in Health Care’Tilburg UniversityTilburgthe Netherlands
| | - Roland Friele
- Netherlands Institute for Health Services Research (NIVEL)Utrechtthe Netherlands
- ‘Social Impact of Health Law’Tilburg UniversityTilburgthe Netherlands
| | - Jany Rademakers
- Netherlands Institute for Health Services Research (NIVEL)Utrechtthe Netherlands
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Schmid A, Varkevisser M. Hospital merger control in Germany, the Netherlands and England: Experiences and challenges. Health Policy 2016; 120:16-25. [DOI: 10.1016/j.healthpol.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
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Boachie MK. Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana. Int J Health Policy Manag 2015; 5:155-63. [PMID: 26927586 PMCID: PMC4770921 DOI: 10.15171/ijhpm.2015.191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 10/16/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP. METHODS Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. RESULTS Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level. CONCLUSION Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels by ensuring constant availability of essential drugs, doctors, and shorter waiting time. However, individual enrolees may value each criterion differently. Thus, not all enrolees may be motivated by same concerns. This requires providers to be circumspect regarding the factors that may attract enrolees. The National Health Insurance Authority (NHIA) should also ensure timely release of funds to help providers procure the necessary medical supplies to ensure quality service.
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Beukers PDC, Kemp RGM, Varkevisser M. Patient hospital choice for hip replacement: empirical evidence from the Netherlands. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:927-36. [PMID: 24158316 DOI: 10.1007/s10198-013-0535-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 09/23/2013] [Indexed: 05/16/2023]
Abstract
In the Dutch health care system, hospitals are expected to compete. A necessary condition for competition among hospitals is that patients do not automatically choose the nearest hospital, but are-at least to some extent-sensitive to differences in hospital quality. In this study, an analysis is performed on the underlying features of patient hospital choice in a setting where prices do not matter for patients as a result of health insurance coverage. Using claims data from all Dutch hospitals over the years 2008-2010, a conditional logit model examines the relationship between patient characteristics (age, gender and reoperations) and hospital attributes (hospital quality information, waiting times on treatments and travel time for patients to the hospitals) in the market for general non-emergency hip replacement treatments. The results show that travel time is the most important determinant in patient hospital choice. From our analysis, however, it follows that publicly available hospital quality ratings and waiting times also have a significant impact on patient hospital choice. The panel data used for this study (2008-2010) is rather short, which may explain why no coherent and persistent changes in patient hospital choice behaviour over time are found.
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Affiliation(s)
- Puck D C Beukers
- Performation Healthcare Intelligence B.V., Bilthoven, The Netherlands
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Concentration of gynaecology and obstetrics in Germany: is comprehensive access at stake? Health Policy 2014; 118:396-406. [PMID: 25201487 DOI: 10.1016/j.healthpol.2014.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 07/07/2014] [Accepted: 07/25/2014] [Indexed: 11/24/2022]
Abstract
Financial soundness will become more and more difficult in the future for all types of hospitals. This is particularly relevant for gynaecology and obstetrics departments: while some disciplines can expect higher demand due to demographic changes and progress in medicine and medical technology, the inpatient sector for gynaecology and obstetrics is likely to lose patients in line with these trends. In this paper we estimate future demand for gynaecology and obstetrics in Germany and develop a cost model to calculate the average profitability in this discipline. The number of inpatient cases in gynaecology and obstetrics can be expected to decrease by 3.62% between 2007 and 2020 due to the demographic change and a potential shift from inpatient to outpatient services. Small departments within the fields of gynaecology and obstetrics are already incurring heavy losses, and the anticipated decline in cases should increase this financial distress even more. As such, the further centralisation of services is indicated. We calculate travel times for gynaecology and obstetrics patients and estimate the anticipated changes in travel times by simulating different scenarios for this centralisation process. Our results show that the centralisation of hospital services in gynaecology and obstetrics may be possible without compromising comprehensive access as measured by travel times.
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Schut FT, Varkevisser M. Tackling hospital waiting times: The impact of past and current policies in the Netherlands. Health Policy 2013; 113:127-33. [DOI: 10.1016/j.healthpol.2013.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 05/05/2013] [Accepted: 05/09/2013] [Indexed: 10/26/2022]
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Bianco A, Molè A, Nobile CGA, Di Giuseppe G, Pileggi C, Angelillo IF. Hospital readmission prevalence and analysis of those potentially avoidable in southern Italy. PLoS One 2012; 7:e48263. [PMID: 23133624 PMCID: PMC3487865 DOI: 10.1371/journal.pone.0048263] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 09/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background One quality indicator of hospital care, which can be used to judge the process of care, is the prevalence of hospital readmission because it reflects the impact of hospital care on the patient’s condition after discharge. The purposes of the study were to measure the prevalence of hospital readmissions, to identify possible factors that influence such readmission and to measure the prevalence of readmissions potentially avoidable in Italy. Methods A sample of 2289 medical records of patients aged 18 and over admitted for medical or surgical illness at one 502-bed community non-teaching hospital were randomly selected. Results A total of 2252 patients were included in the final analysis, equaling a response rate of 98.4%. The overall hospital readmission prevalence within 30 days of discharge was 10.2%. Multivariate logistic regression analysis revealed that the proportion of patients readmitted within 30 days of discharge significantly increased regardless of Charlson et al. comorbidity score, among unemployed or retired patients, and in patients in general surgery. A total of 43.7% hospital readmissions were judged to be potentially avoidable. Multivariate logistic regression analysis showed that potentially avoidable readmissions were significantly higher in general surgery, in patients referred to hospital by an emergency department physician, and in those with a shortened time between discharge and readmission. Conclusion Additional research on intervention or bundle of interventions applicable to acute inpatient populations that aim to reduce potentially avoidable readmissions is strongly needed, and health care providers are urged to implement evidence-based programs for more cost-effective delivery of health care.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Antonio Molè
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Carmelo G. A. Nobile
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | | | - Claudia Pileggi
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Italo F. Angelillo
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
- * E-mail:
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Schmid A, Ulrich V. Consolidation and concentration in the German hospital market: the two sides of the coin. Health Policy 2012; 109:301-10. [PMID: 22944048 DOI: 10.1016/j.healthpol.2012.08.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 07/24/2012] [Accepted: 08/10/2012] [Indexed: 11/16/2022]
Abstract
In many countries, policy makers try to increase quality and efficiency in the hospital sector by fostering competition. The German hospital market is a good example of this approach and the challenges that come with it. We focus on market concentration which is both a result of and a potential threat to more competition. This study gives a detailed account of health reform in the German hospital sector and illustrates international experience with regard to market concentration. For the first time, concentration measures are consistently calculated at hospital system level. To make the results exploitable for comparative studies, this approach is described in detail. Patient flows are analyzed using data from the German hospital census, which is augmented with external data such as an indicator for the structures of urban and rural development. Our findings indicate that just some years after hospital competition was intensified, more than one third of German hospitals are located in strongly concentrated markets. Rural areas are especially prone to this development. If system membership is not accounted for, concentration is considerably underestimated. Policy makers are strongly advised to take precautions against excessive market concentration before promoting competition, as once consolidated, structures are difficult to unbundle.
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Affiliation(s)
- Andreas Schmid
- University of Bayreuth, Chair of Public Finance, VWL III, 95440 Bayreuth, Germany.
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Victoor A, Delnoij DMJ, Friele RD, Rademakers JJDJM. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Serv Res 2012; 12:272. [PMID: 22913549 PMCID: PMC3502383 DOI: 10.1186/1472-6963-12-272] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. METHODS We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. RESULTS Our review shows that patients' choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. CONCLUSIONS There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several knowledge gaps were identified that need follow-up research.
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Affiliation(s)
- Aafke Victoor
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, Netherlands
| | - Diana MJ Delnoij
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tranzo, P.O. Box 90153, 5000 LE, Tilburg, Netherlands
- Centre for Consumer Experience in Health Care (CKZ), P.O. Box 1568, 3500 BN, Utrecht, Netherlands
| | - Roland D Friele
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, Netherlands
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tranzo, P.O. Box 90153, 5000 LE, Tilburg, Netherlands
| | - Jany JDJM Rademakers
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN, Utrecht, Netherlands
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Sivey P. The effect of waiting time and distance on hospital choice for English cataract patients. HEALTH ECONOMICS 2012; 21:444-456. [PMID: 21384464 DOI: 10.1002/hec.1720] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 12/23/2010] [Accepted: 01/11/2011] [Indexed: 05/30/2023]
Abstract
This paper applies latent-class multinomial logit models to the choice of hospital for cataract operations in the UK NHS. We concentrate on the effects of travel time and waiting time and especially on estimating the waiting time elasticity of demand. Models including hospital fixed effects rely on changes over time in waiting time to indentify coefficients. We show how using a latent-class multinomial logit model characterises the unobserved heterogeneity in GP practices' choice behaviour and affects the estimated elasticities of travel time and waiting time. The models estimate waiting time elasticities of demand of approximately -0.1, comparable with previous waiting time-demand models. For the average waiting time elasticity, the simple multinomial logit models are good approximations of the latent-class logit results.
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Affiliation(s)
- Peter Sivey
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Parkville, Victoria, Australia.
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The impact of geographic market definition on the stringency of hospital merger control in Germany and the Netherlands. HEALTH ECONOMICS POLICY AND LAW 2012; 7:363-81. [DOI: 10.1017/s1744133112000011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIn markets where hospitals are expected to compete, preventive merger control aims to prohibit anticompetitive mergers. In the hospital industry, however, the standard method for defining the relevant market (SSNIP) is difficult to apply and alternative approaches have proven inaccurate. Experiences from the United States show that courts, by identifying overly broad geographic markets, have underestimated the anticompetitive effects of hospital mergers. We examine how geographic hospital markets are defined in Germany and the Netherlands where market-oriented reforms have created room for hospital competition. For each country, we discuss a landmark case where definition of the geographic market played a decisive role. Our findings indicate that defining geographic hospital markets in both countries is less complicated than in the United States, where antitrust analysis must take managed care organisations into account. We also find that different methods result in much more stringent hospital merger control in Germany than in the Netherlands. Given the uncertainties in defining hospital markets, the German competition authority seems to be inclined to avoid the risk of being too permissive; the opposite holds for the Dutch competition authority. We argue that for society the costs of being too permissive with regard to hospital mergers may be larger than the costs of being too stringent.
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Lorenzetti DL, Noseworthy T. Patient choice systems and waiting times for scheduled services. Healthc Manage Forum 2011; 24:57-62. [PMID: 21899225 DOI: 10.1016/j.hcmf.2011.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Access to scheduled healthcare is a continuing challenge. A synthesis of the international literature was conducted to examine the potential of patient choice systems to reduce waiting times in Canada. A multitude of factors appear to influence the actions and outcomes of patients, providers, and systems. For choice systems to be effective, there must be uptake, which requires incentives and supports. Choice should be considered as but one element of a comprehensive waiting time management strategy.
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Affiliation(s)
- Diane L Lorenzetti
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms? HEALTH ECONOMICS POLICY AND LAW 2010; 5:343-63. [DOI: 10.1017/s1744133110000071] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIn the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.
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