Accessibility statement

Competition and equity in health care

Competition is a perennial policy prescription for reducing cost and improving quality.  However, critics worry that competition may undermine socioeconomic equity in health care.  In projects funded by the ESRC, MRC and NIHR SDO programme, researchers at CHE have examined this empirical hypothesis by exploiting two “natural experiments” in the English NHS.  First, the Thatcher/Major “internal market” reforms in the 1990s introduced by a Conservative administration, and second, the Blair/Brown NHS reforms in the 2000s introduced by a Labour administration.  We used comprehensive national data on hospital utilisation by all NHS patients, comparing use of services in more and less deprived small areas.  In both cases, we found that competition had little or no effect on equity in the use of hospital services. 

For further details see

  • Example publications:
    • Cookson R, Laudicella M, Li Donni P. Does hospital competition harm equity? Evidence from the English National Health Service. Journal of Health Economics 2013;32(2):410-422. Download from ScienceDirect
    • Cookson R, Laudicella M, Li Donni P, Dusheiko M. Effects of the Blair/Brown health reforms on socioeconomic equity in health care. Journal of Health Services Research and Policy 2012;17(Suppl1):55-63. 
    • Cookson R, Dusheiko M, Hardman G, Martin S. Competition and inequality: evidence from the English National Health Service 1991-2001. Journal of Public Administration Research and Theory 2010;20 i181-i205. Download from Oxford Journals.
  • Contact: Richard Cookson