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New Joints: Private providers and rising demand in the English National Health Service

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  • Elaine Kelly

    (Institute for Fiscal Studies and Institute for Fiscal Studies)

  • George Stoye

    (Institute for Fiscal Studies and Institute for Fiscal Studies)

Abstract

Reforms to public services have extended consumer choice by allowing for the entry of private providers. The aim is to generate competitive pressure to improve quality when consumers choose between providers. However, for many services new entrants could also affect whether a consumer demands the service at all. We explore this issue by considering how demand for elective surgery responds following the entry of private providers into the market for publicly funded health care in England. For elective hip replacements, we find that demand shifts account for at least 7% of public procedures conducted by private hospitals. These results are robust to instrumenting for location using the presence of existing healthcare facilities. Exploiting rarely used clinical audit data, we show that these additional procedures are not substitutions from privately funded procedures, and represent new surgeries, at least within a given year. The increase in volumes resulting from a demand shift improve consumer welfare, but impose fiscal costs, and do not contribute the original aim of the reforms to stimulate competition. This is an updated version of W15/22 New joints: private providers and rising demand in the English National Health Service.

Suggested Citation

  • Elaine Kelly & George Stoye, 2016. "New Joints: Private providers and rising demand in the English National Health Service," IFS Working Papers W16/15, Institute for Fiscal Studies.
    • Handle: RePEc:ifs:ifsewp:16/15
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    Cited by:

    1. Bíró, Anikó & Hellowell, Mark, 2016. "Public–private sector interactions and the demand for supplementary health insurance in the United Kingdom," Health Policy, Elsevier, vol. 120(7), pages 840-847.
    2. Cooper, Zack & Gibbons, Stephen & Skellern, Matthew, 2018. "Does competition from private surgical centres improve public hospitals' performance? Evidence from the English National Health Service," Journal of Public Economics, Elsevier, vol. 166(C), pages 63-80.
    3. Brenna, Elenka & Polistena, Barbara & Spandonaro, Federico, 2023. "Analysing outpatient care access for planning purposes: The Basilicata Region experience," Evaluation and Program Planning, Elsevier, vol. 99(C).
    4. Laurie Rachet-Jacquet & Nils Gutacker & Luigi Siciliani, 2019. "The causal effect of hospital volume on health gains from hip replacement surgery," Working Papers 168cherp, Centre for Health Economics, University of York.
    5. Dardanoni, V.; & Laudicella, M.; & Li Donni, P.;, 2018. "Hospital Choice in the NHS," Health, Econometrics and Data Group (HEDG) Working Papers 18/04, HEDG, c/o Department of Economics, University of York.
    6. 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.
    7. Fletcher, Simon & Eddama, Oya & Anderson, Michael & Meacock, Rachel & Wattal, Vasudha & Allen, Pauline & Peckham, Stephen, 2024. "The impact of NHS outsourcing of elective care to the independent sector on outcomes for patients, healthcare professionals and the United Kingdom health care system: a rapid narrative review of liter," LSE Research Online Documents on Economics 125828, London School of Economics and Political Science, LSE Library.

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    More about this item

    Keywords

    public service choice; healthcare demand; geographic variation;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L33 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Comparison of Public and Private Enterprise and Nonprofit Institutions; Privatization; Contracting Out

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