Divided by choice? For-profit providers, patient choice and mechanisms of patient sorting in the English National Health Service.
Divided by choice? For-profit providers, patient choice and mechanisms of patient sorting in the English National Health Service.
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DOI：
10.1002/hec.4223
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发表时间：
2021-04
期刊：
影响因子：
2.1
通讯作者：
Kelly E
中科院分区：
文献类型：
--
作者：
Beckert W;Kelly E
本文研究了2000年代政府改革后患者对供应商的选择，这使得盈利外科中心能够与英国现有的公共国家卫生服务（NHS）医院竞争。盈利供应商提供显著的好处，特别是更短的等待时间。我们估计了不同类型的患者从改革中受益的程度，并调查了导致差异收益的机制。我们的反事实模拟表明，就获取的价值而言，营利提供者的进入使最富有的患者受益是最贫穷的患者的两倍，白人患者是少数民族患者的六倍。这些差异的一半可以用医疗地理和患者健康来解释，而初级保健转诊实践的作用较小，但不可忽略。我们还表明，在按资本偿还的情况下，营利外科中心和现有公立医院之间患者风险的不同构成使公立医院处于竞争劣势。
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.
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