Competition and Inequality: Evidence from the English National Health Service 1991-2001
Competition and Inequality: Evidence from the English National Health Service 1991-2001
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DOI：
10.1093/jopart/muq021
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发表时间：
2010-07-01
影响因子：
4.2
通讯作者：
Martin, Stephen
中科院分区：
文献类型：
--
作者：
Cookson, Richard;Dusheiko, Mark;Martin, Stephen
竞争常常被当作提高效率的补品，用于改善健康状况不佳的系统。然而，批评人士声称，竞争加剧了医疗保健领域的社会经济不平等。这一说法是测试有关的“内部市场”改革的英国国民保健服务（NHS）从1991年至1997年，注入了一个小剂量的医院竞争到国家资助的，国有的卫生系统负责超过90%的国家卫生支出。我们的因变量是1991年至2001年英国8,500个小地区的NHS医院髋关节置换和心脏血运重建的利用率。我们估计小面积水平之间的关联剥夺和医院利用率，允许需求和供应变量。然后，我们比较了逐年之间的不平等差异与“潜在的竞争”和“非竞争”的地方医院市场，竞争是分阶段的。没有证据表明竞争对社会经济卫生保健不平等有任何影响。
Competition is often prescribed as an efficiency-enhancing tonic for ailing health systems. However, critics claim that competition exacerbates socioeconomic inequality in health care. This claim is tested in relation to the "internal market" reforms of the English National Health Service (NHS) from 1991 to 97, which injected a small dose of hospital competition into a state-funded, state-owned health system responsible for more than 90% of national health expenditure. Our dependent variables are NHS hospital utilization rates for hip replacement and heart revascularization in 8,500 English small areas from 1991 to 2001. We estimate small area level associations between deprivation and hospital utilization, allowing for need and supply variables. We then compare year-by-year inequality differences between areas with "potentially competitive" and "noncompetitive" local hospital markets, as competition was phased in and out. No evidence is found that competition had any effect on socioeconomic health care inequality.