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Waiting times spillovers in a National Health Service hospital network: a little organizational diversity can go a long way

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  • Joana Daniela Ferreira Cima

    (Escola de Economia e Gestão, Universidade do Minho)

  • Alvaro Fernando Santos Almeida

    (cef.up Center for Economics and Finance at UPorto)

Abstract

Background The objective of this study is to assess if waiting times for elective surgeries within the Portuguese National Health Service (NHS) are influenced by the waiting times at neighboring hospitals. Recognizing these interdependencies, and their extent, is crucial for understanding how hospital network dynamics affect healthcare delivery efficiency and patient access. Methods We utilized patient-level data from all elective surgeries conducted in Portuguese NHS hospitals to estimate a hospital-specific index for waiting times. This index served as the dependent variable in our analysis. We applied a spatial lag model to examine the potential strategic interactions between hospitals concerning their waiting times. Results Our analysis revealed a significant positive endogenous spatial dependence, indicating that waiting times in NHS hospitals are strategic complements. Furthermore, we found that NHS contracts with private not-for-profit hospitals not only reduce waiting times within these hospitals but also exert positive spillover effects on other NHS hospitals. Conclusions The findings suggest that diversifying the organization of the NHS hospital network, particularly through contracts with private entities for marginal patients, can significantly enhance competitive dynamics and reduce waiting times. This effect persists even when patient choice is confined to a small fraction of the patient population, highlighting a strategic avenue for policy optimization in healthcare service delivery.

Suggested Citation

  • Joana Daniela Ferreira Cima & Alvaro Fernando Santos Almeida, 2024. "Waiting times spillovers in a National Health Service hospital network: a little organizational diversity can go a long way," Health Economics Review, Springer, vol. 14(1), pages 1-12, December.
    • Handle: RePEc:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-024-00555-x
    DOI: 10.1186/s13561-024-00555-x
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    References listed on IDEAS

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    1. Kurt R. Brekke & Hugh Gravelle & Luigi Siciliani & Odd Rune Straume, 2014. "Patient Choice, Mobility and Competition Among Health Care Providers," Developments in Health Economics and Public Policy, in: Rosella Levaggi & Marcello Montefiori (ed.), Health Care Provision and Patient Mobility, edition 127, pages 1-26, Springer.
    2. Diane Dawson & Hugh Gravelle & Rowena Jacobs & Stephen Martin & Peter C. Smith, 2007. "The effects of expanding patient choice of provider on waiting times: evidence from a policy experiment," Health Economics, John Wiley & Sons, Ltd., vol. 16(2), pages 113-128, February.
    3. Honora Smith & Christine Currie & Pornpimol Chaiwuttisak & Andreas Kyprianou, 2018. "Patient choice modelling: how do patients choose their hospitals?," Health Care Management Science, Springer, vol. 21(2), pages 259-268, June.
    4. Fernández-Pérez, Ángel & Jiménez-Rubio, Dolores & Robone, Silvana, 2022. "Freedom of choice and health services’ performance: Evidence from a national health system," Health Policy, Elsevier, vol. 126(12), pages 1283-1290.
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    More about this item

    Keywords

    Waiting times; Not-for-profit hospitals; Mixed markets; Hospital competition;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out
    • H44 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Goods: Mixed Markets

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