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Divided by choice? For‐profit providers, patient choice and mechanisms of patient sorting in the English National Health Service
Health Economics ( IF 2.1 ) Pub Date : 2021-02-05 , DOI: 10.1002/hec.4223
Walter Beckert 1 , Elaine Kelly 2
Affiliation  

This paper studies patient choice of provider following government reforms in the 2000s, which allowed for‐profit surgical centers to compete with existing public National Health Service (NHS) hospitals in England. For‐profit providers offer significant benefits, notably shorter waiting times. We estimate the extent to which different types of patients benefit from the reforms, and we investigate mechanisms that cause differential benefits. Our counterfactual simulations show that, in terms of the value of access, entry of for‐profit providers benefitted the richest patients twice as much as the poorest, and white patients six times as much as ethnic minority patients. Half of these differences is explained by healthcare geography and patient health, while primary care referral practice plays a lesser, though non‐negligible role. We also show that, with capitated reimbursement, different compositions of patient risks between for‐profit surgical centers and existing public hospitals put public hospitals at a competitive disadvantage.

中文翻译:

按选择划分?英国国民健康服务中的营利性提供者、患者选择和患者分类机制

本文研究了 2000 年代政府改革后患者对提供者的选择,该改革允许营利性手术中心与英国现有的公共国民健康服务 (NHS) 医院竞争。营利性提供者提供了显着的好处,尤其是更短的等待时间。我们估计了不同类型患者从改革中受益的程度,并调查了导致不同收益的机制。我们的反事实模拟表明,就访问价值而言,营利性提供者的进入使最富有的患者受益是最贫困患者的两倍,白人患者是少数族裔患者的六倍。这些差异中有一半是由医疗保健地理和患者健康造成的,而初级保健转诊实践的作用较小,但不可忽视。我们还表明,
更新日期:2021-03-15
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