IDEAS home Printed from https://ideas.repec.org/p/yor/hectdg/19-21.html
   My bibliography  Save this paper

The Effect of Freedom of Choice on Health System Responsiveness. Evidence from Spain

Author

Listed:
  • Fernández-Pérez, A.;
  • Jiménez-Rubio, D.;
  • Robone, S.;

Abstract

Public policies fostering the freedom of choice in the healthcare sector are becoming increasingly usual in Europe in order to boost patient empowerment and improving health system responsiveness. However, there is limited evidence regarding the effects of freedom of choice policies. The goal of this study is to contribute to this literature by analysing the impact of the implementation of the Single Health Area in the Spanish region of Madrid in 2009. This reform allowed citizens to freely choose among any General Practitioner and Specialist of any health centre of the region. We focus on studying the effect on the health services responsiveness -as defined by the World Health Organization - drawing on cross-section microdata from the Spanish Healthcare Barometer for 2002-2016 and making use of the synthetic control estimation techniques. The findings show that the reform caused a strong positive impact on the Prompt Attention domain in specialised care. By contrast, the reform caused a drop in the responsiveness with Communication and Dignity domains in primary care. The results of this paper could provide policy-makers with empirical evidence about the impact of the freedom of choice policies on the quality of care provided by the health services.

Suggested Citation

  • Fernández-Pérez, A.; & Jiménez-Rubio, D.; & Robone, S.;, 2019. "The Effect of Freedom of Choice on Health System Responsiveness. Evidence from Spain," Health, Econometrics and Data Group (HEDG) Working Papers 19/21, HEDG, c/o Department of Economics, University of York.
    • Handle: RePEc:yor:hectdg:19/21
    as

    Download full text from publisher

    File URL: https://www.york.ac.uk/media/economics/documents/hedg/workingpapers/1921.pdf
    File Function: Main text
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Daron Acemoglu & Davide Cantoni & Simon Johnson & James A. Robinson, 2011. "The Consequences of Radical Reform: The French Revolution," American Economic Review, American Economic Association, vol. 101(7), pages 3286-3307, December.
    2. Alberto Abadie & Alexis Diamond & Jens Hainmueller, 2015. "Comparative Politics and the Synthetic Control Method," American Journal of Political Science, John Wiley & Sons, vol. 59(2), pages 495-510, February.
    3. Marco Varkevisser & Stéphanie Geest, 2007. "Why do patients bypass the nearest hospital? An empirical analysis for orthopaedic care and neurosurgery in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 287-295, September.
    4. Glenngård, Anna H. & Anell, Anders & Beckman, Anders, 2011. "Choice of primary care provider: Results from a population survey in three Swedish counties," Health Policy, Elsevier, vol. 103(1), pages 31-37.
    5. Pedro Pita Barros & Werner B. F. Brouwer & Sarah Thomson & Marco Varkevisser, 2016. "Competition among health care providers: helpful or harmful?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(3), pages 229-233, April.
    6. Marco Varkevisser & Stéphanie Geest & Frederik Schut, 2010. "Assessing hospital competition when prices don’t matter to patients: the use of time-elasticities," International Journal of Health Economics and Management, Springer, vol. 10(1), pages 43-60, March.
    7. Martin Gaynor & Carol Propper & Stephan Seiler, 2016. "Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service," American Economic Review, American Economic Association, vol. 106(11), pages 3521-3557, November.
    8. Francesco Longo & Luigi Siciliani & Giuseppe Moscelli & Hugh Gravelle, 2019. "Does hospital competition improve efficiency? The effect of the patient choice reform in England," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 618-640, May.
    9. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    10. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2016. "Market structure, patient choice and hospital quality for elective patients," Working Papers 139cherp, Centre for Health Economics, University of York.
    11. Paolo Pinotti, 2015. "The Economic Costs of Organised Crime: Evidence from Southern Italy," Economic Journal, Royal Economic Society, vol. 125(586), pages 203-232, August.
    12. Abadie, Alberto & Diamond, Alexis & Hainmueller, Jens, 2010. "Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program," Journal of the American Statistical Association, American Statistical Association, vol. 105(490), pages 493-505.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Alzahrani, Ahmed Ibrahim & Al-Samarraie, Hosam & Eldenfria, Atef & Dodoo, Joana Eva & Alalwan, Nasser, 2022. "Users’ intention to continue using mHealth services: A DEMATEL approach during the COVID-19 pandemic," Technology in Society, Elsevier, vol. 68(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. 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.
    2. Visa Pitkänen & Ismo Linnosmaa, 2021. "Choice, quality and patients’ experience: evidence from a Finnish physiotherapy service," International Journal of Health Economics and Management, Springer, vol. 21(2), pages 229-245, June.
    3. Anne-Fleur Roos & Eddy van Doorslaer & Owen O'Donnell & Erik Schut & Marco Varkevisser, 2018. "Does price competition damage healthcare quality?," Tinbergen Institute Discussion Papers 18-040/V, Tinbergen Institute.
    4. Niklas Potrafke & Fabian Ruthardt & Kaspar Wuthrich, 2020. "Protectionism and economic growth: Causal evidence from the first era of globalization," Papers 2010.02378, arXiv.org, revised Mar 2022.
    5. Cummins Joseph & Miller Douglas L. & Smith Brock & Simon David, 2024. "Matching on Noise: Finite Sample Bias in the Synthetic Control Estimator," Journal of Econometric Methods, De Gruyter, vol. 13(1), pages 67-95, January.
    6. Lippi Bruni, Matteo & Ugolini, Cristina & Verzulli, Rossella, 2021. "Should I wait or should I go? Travelling versus waiting for better healthcare," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    7. Monastiriotis, Vassilis & Zilic, Ivan, 2020. "The economic effects of political disintegration: Lessons from Serbia and Montenegro," European Journal of Political Economy, Elsevier, vol. 65(C).
    8. Mennicken, Roman & Kolodziej, Ingo W.K. & Augurzky, Boris & Kreienberg, Rolf, 2014. "Concentration of gynaecology and obstetrics in Germany: Is comprehensive access at stake?," Health Policy, Elsevier, vol. 118(3), pages 396-406.
    9. Giulio Grossi & Marco Mariani & Alessandra Mattei & Patrizia Lattarulo & Ozge Oner, 2020. "Direct and spillover effects of a new tramway line on the commercial vitality of peripheral streets. A synthetic-control approach," Papers 2004.05027, arXiv.org, revised Nov 2023.
    10. Peter Dohmen & Martin Ineveld & Aniek Markus & Liana Hagen & Joris Klundert, 2023. "Does competition improve hospital performance: a DEA based evaluation from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 999-1017, August.
    11. David Gilchrist & Thomas Emery & Nuno Garoupa & Rok Spruk, 2023. "Synthetic Control Method: A tool for comparative case studies in economic history," Journal of Economic Surveys, Wiley Blackwell, vol. 37(2), pages 409-445, April.
    12. Isaksen, Elisabeth Thuestad, 2020. "Have international pollution protocols made a difference?," Journal of Environmental Economics and Management, Elsevier, vol. 103(C).
    13. Anell, Anders & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2021. "Information, switching costs, and consumer choice: Evidence from two randomised field experiments in Swedish primary health care," Journal of Public Economics, Elsevier, vol. 196(C).
    14. Bibek Adhikari, 2022. "A Guide to Using the Synthetic Control Method to Quantify the Effects of Shocks, Policies, and Shocking Policies," The American Economist, Sage Publications, vol. 67(1), pages 46-63, March.
    15. Bueno, Matheus & Valente, Marica, 2019. "The effects of pricing waste generation: A synthetic control approach," Journal of Environmental Economics and Management, Elsevier, vol. 96(C), pages 274-285.
    16. Becker, Maike & Pfeifer, Gregor & Schweikert, Karsten, 2021. "Price Effects of the Austrian Fuel Price Fixing Act: A Synthetic Control Study," Energy Economics, Elsevier, vol. 97(C).
    17. Steinkraus, Arne, 2018. "Rethinking Policy Evaluation – Do Simple Neural Nets Bear Comparison with Synthetic Control Method?," EconStor Preprints 177390, ZBW - Leibniz Information Centre for Economics.
    18. Parast Layla & Hunt Priscillia & Griffin Beth Ann & Powell David, 2020. "When is a Match Sufficient? A Score-based Balance Metric for the Synthetic Control Method," Journal of Causal Inference, De Gruyter, vol. 8(1), pages 209-228, January.
    19. Juan S. Mora‐Sanguinetti & Rok Spruk, 2023. "Economic effects of recent experiences of federalism: Analysis of the regionalization process in Spain," Journal of Regional Science, Wiley Blackwell, vol. 63(1), pages 30-63, January.
    20. Schut, Frederik T. & Varkevisser, Marco, 2013. "Tackling hospital waiting times: The impact of past and current policies in the Netherlands," Health Policy, Elsevier, vol. 113(1), pages 127-133.

    More about this item

    Keywords

    health system responsiveness; synthetic control method; freedom of choice;
    All these keywords.

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:yor:hectdg:19/21. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Jane Rawlings (email available below). General contact details of provider: https://edirc.repec.org/data/deyoruk.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.