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The effect of hospital ownership on quality of care: evidence from England

Author

Listed:
  • Giuseppe Moscelli

    (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK)

  • Hugh Gravelle

    (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK.)

  • Luigi Siciliani

    (Department of Economics and Related Studies, University of York, York, UK)

  • Nils Gutacker

    (Economics of Social and Health Care Research Unit, Centre for Health Economics, University of York, York, UK)

Abstract

We investigate whether quality of care differs between public and private hospitals in England with data on 3.8 million publicly-funded patients receiving 133 planned (non-emergency) treatments in 393 public and 190 private hospitalsites. Private hospitals treat patients with fewer comorbidities and past hospitalisations. Controlling for observed patient characteristics and treatment type, private hospitals have fewer emergency readmissions. Conversely, after instrumenting the choice of hospital type by the difference in distances from the patient to the nearest public and the nearest private hospital, the effect of ownership is smaller and statistically insignificant. Similar results are obtained with coarsened exact matching. We also find no quality differences between hospitals specialising in planned treatments and other hospitals, nor between for-profit and not-for-profit private hospitals. Our results show the importance of controlling for unobserved patient heterogeneity when comparing quality of public and private hospitals.

Suggested Citation

  • Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani & Nils Gutacker, 2017. "The effect of hospital ownership on quality of care: evidence from England," Working Papers 145cherp, Centre for Health Economics, University of York.
    • Handle: RePEc:chy:respap:145cherp
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    Cited by:

    1. Walter Beckert & Elaine Kelly, 2021. "Divided by choice? For‐profit providers, patient choice and mechanisms of patient sorting in the English National Health Service," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 820-839, April.
    2. Levaggi, Laura & Levaggi, Rosella, 2020. "Is there scope for mixed markets in the provision of hospital care?," Social Science & Medicine, Elsevier, vol. 247(C).
    3. Moscone, Francesco & Siciliani, Luigi & Tosetti, Elisa & Vittadini, Giorgio, 2020. "Do public and private hospitals differ in quality? Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 83(C).
    4. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2021. "Hospital competition and quality for non‐emergency patients in the English NHS," RAND Journal of Economics, RAND Corporation, vol. 52(2), pages 382-414, June.
    5. Moscelli, G.; & Sayli, M.; & Blanden, J.; & Mello, M.; & Castro-Pires, H.; & Bojke, C.;, 2023. "Non-monetary interventions, workforce retention and hospital quality: evidence from the English NHS," Health, Econometrics and Data Group (HEDG) Working Papers 23/13, HEDG, c/o Department of Economics, University of York.
    6. Martin Chalkley, 2018. "Private Provision of Publicly Funded Health Care: The Economics of Ownership," Briefing 002055, Office of Health Economics.
    7. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2018. "Effects of Market Structure and Patient Choice on Hospital Quality for Planned Patients," School of Economics Discussion Papers 1118, School of Economics, University of Surrey.
    8. András Kiss & Norbert Kiss & Balázs Váradi, 2023. "Do budget constraints limit access to health care? Evidence from PCI treatments in Hungary," International Journal of Health Economics and Management, Springer, vol. 23(2), pages 281-302, June.
    9. Milcent, Carine, 2023. "The sorting effect in healthcare access: Those left behind," Economics & Human Biology, Elsevier, vol. 51(C).
    10. Rachet-Jacquet, Laurie & Gutacker, Nils & Siciliani, Luigi, 2021. "Scale economies in the health sector: The effect of hospital volume on health gains from hip replacement surgery," Journal of Economic Behavior & Organization, Elsevier, vol. 190(C), pages 704-729.
    11. Levaggi, Laura & Levaggi, Rosella, 2023. "Competition in the provision of hospital care: Are mixed markets a valid alternative?," Economic Modelling, Elsevier, vol. 127(C).
    12. Moscelli, Giuseppe & Sayli, Melisa & Blanden, Jo & Mello, Marco & Castro-Pires, Henrique & Bojke, Chris, 2023. "Non-monetary Interventions, Workforce Retention and Hospital Quality: Evidence from the English NHS," IZA Discussion Papers 16379, Institute of Labor Economics (IZA).
    13. Alex Bawuah & Simon Appleton & Yang Li, 2024. "The effect of health facility ownership on perceived healthcare quality: evidence from Ghana," International Journal of Health Economics and Management, Springer, vol. 24(4), pages 571-593, December.

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    More about this item

    Keywords

    ownership; hospital; quality; choice; distance; endogeneity.;
    All these keywords.

    JEL classification:

    • C36 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Instrumental Variables (IV) Estimation
    • H44 - Public Economics - - Publicly Provided Goods - - - Publicly Provided Goods: Mixed Markets
    • 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

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