Accessibility statement

Measuring health & quality of care



The primary objective of healthcare systems is to maintain or improve patients’ health with its given resources. Healthcare providers such as hospitals, GPs or NHS nursing homes may vary in the quality of the care they provide, with notable failures giving rise to widespread public concern (see for example the Francis Inquiry report). It is therefore vital to measure, monitor and appropriately incentivise the quality and safety of care provided and assess its impact on the health and wellbeing of both patients and their families. Our contributions to this area of research include:

  • use of health outcome measures, including those reported by patients themselves, to quantify provider variation in quality
  • design and evaluation of casemix adjustment systems
  • identification of safety events in administrative data
  • international comparisons of healthcare quality
  • determinants of quality and safety in healthcare providers
  • issues surrounding the construction of composite indicators of quality performance
  • evaluation of quality of care under different incentive arrangements, including pay-for performance

Contact: Nils Gutacker




  • Jacob N, Munford L, Rice N, Roberts J. Does commuting mode choice impact health? Health Economics 2021;30(2):207-230. Download from Wiley
  • Stokes J, Guthrie B, Mercer SW, Rice N, Sutton M. Multimorbidity combinations, costs of hospital care and potentially preventable emergency admissions in England: A cohort study. Plos Medicine 2021;18(1):e1003514. Download from Plos Journals site


  • Abramovich A, de Oliveira C, Kiran T, Iwajomo T, Ross LE, Kurdyak P. Assessment of health conditions and health service use among transgender patients in Canada. JAMA Network Open 2020;3(8):e2015036. Download from Jamanet
  • Biswas A, Dobson KG, Gignac MAM, de Oliveira C, Smith PM. Changes in work factors and concurrent changes in leisure time physical activity: A 12-year longitudinal analysis. Occupational and Environmental Medicine 2020;77(5):309-315. Download from BMJ
  • Chan K, Nam S, Evans B, de Oliveira C, Chambers A, Gavura S et al. Developing a framework to incorporate real-world evidence in cancer drug funding decisions: The Canadian Real-world Evidence for Value of Cancer Drugs (CanREValue) collaboration. BMJ Open 2020;10(1):e032884. Download from BMJ
  • Cylus J, Smith PC. The economy of wellbeing: What is it and what are the implications for health? BMJ 2020;369:m1874. Download from BMJ
  • Di Novi C, Jacobs R, Migheli M. Smoking inequality across genders and socio-economic positions. Evidence from Italian data. Journal of Bioeconomics 2020;22(3):177-203. Download from Springer
  • Gaughan J, Siciliani L, Gravelle H, Moscelli G. Do small hospitals have lower quality? Evidence from the English NHS. Social Science & Medicine 2020;265:113500. Download from ScienceDirect
  • Harris M, Knott R, Lorgelly P, Rice N. Using externally collected vignettes to account for reporting heterogeneity in survey self-assessment. Economics Letters 2020;194:109325. Download from Sciencedirect
  • Sun Z, Guerriere DN, de Oliveira C, Coyte PC. Temporal trends in place of death for end-of-life patients: Evidence from Toronto, Canada. Health and Social Care in the Community 2020;28(5):1807-1816. Download from Wiley


  • Gutacker N, Street A. Calls for routine collection of patient-reported outcome measures (PROMs) are getting louder. Journal of Health Services Research & Policy 2019;24(1):1-2. Download from Sage
  • Jacob N, Munford L, Rice N, Roberts J. The disutility of commuting? The effect of gender and local labor markets. Regional Science and Urban Economics2019:77:264-275. Download from Elsevier
  • Jones A, Rice N, Zantomio F. Acute health shocks and labour market outcomes: Evidence from the post crash era. Economics and Human Biology2019;36:100811. Download from Elsevier
  • L’Esperance V, Gravelle H, Schofield P, Santos R, Ashworth M. Relationship between general practice capitation funding and the quality of primary care in England: a cross-sectional, 3-year study. BMJ Open2019;9(11);e030624. Download from BMJ
  • Liu D, Green E, Kasteridis PGoddard MJacobs R, Wittenberg R, Mason A. Incentive schemes to increase dementia diagnoses in primary care in England: a retrospective cohort study of unintended consequences. British Journal of General Practice 2019;69(680):e154-e163. Download from BJGP
  • Liu DMason A, Marks L, Davis H, Hunter DJ, Jehu LM, Smithson J, Visram S. Effects of local authority expenditure on childhood obesity. European Journal of Public Health2019;29(4):785-790. Download from OUP
  • Mason A.Effectiveness of respite care for caregivers of older adults. In: Gu D, Dupre ME (eds). Encyclopedia of Gerontology and Population Aging. Springer, Cham, Switzerland 2019. 
  • Mason ARodriguez Santana IAragón MJ,Rice NChalkley M, Wittenberg R, Fernandez J-L. Drivers of health care expenditure: Final report. Centre for Health Economics, University of York;CHE Research Paper 168 (PDF , 1,811kb)
  • Youn J-H, Stevenson M, Thokala P, Payne K, Goddard M. Modelling the economic impact of interventions for older populations with multimorbidity: A method of linking multiple single-disease models. Medical Decision Making2019;39(7):842-856. Download from Sage


  • Aragon MJ, Chalkley MJ. How do time trends in inhospital mortality compare? A retrospective study of England and Scotland over 17 years using administrative data. BMJ Open 2018;8(2):e107195. Download from BMJ 
  • Bloor K, Goddard M. Public spending must improve health, not just healthcare. BMJ 2018;363:k4673. Download from BMJ  
  • Gutacker N, Bloor KE, Bojke C, Walshe K. Should interventions to reduce variation in care quality target doctors or hospitals? Health Policy 2018;122(6):660-666. Download from ScienceDirect
  • Howdon D, Rice N. Health care expenditures, age, proximity to death and morbidity: implications for an ageing population. Journal of Health Economics 2018;57:60-74. Download from ScienceDirect
  • Jones A, Laporte A, Zucchelli E, Rice N. Dynamic panel data estimation of an integrated Grossman and Becker-Murphy model of health and addiction. Empirical Economics 2018; Download from Springer 
  • Jones A, Rice N, Robone S. Anchoring vignettes and cross-country comparability: an empirical assessment of self-reported mobility. In Baltagi BH, Moscone F (eds). Health Econometrics Contributions to Economic Analysis: Volume 294. Emerald Group Publishing Limited 2018;7.
  • Liu D, Mason A, Marks L, Davis H, Hunter DJ, Jehu LM, Smithson J, Visram S. Effects of local authority expenditure on childhood obesity. European Journal of Public Health 2018;doi:10.1093/eurpub/cky252. Download from OUP 
  • Mason A, Liu D, Kasteridis P, Goddard M, Jacobs R, Wittenberg R, McGonigal G. Investigating the impact of primary care payments on underdiagnosis in dementia: A difference-in-differences analysis. International Journal of Geriatric Psychiatry 2018;33(8):1090-1097. Download from Wiley
  • Moscelli G, Gravelle H, Siciliani L, Gutacker N. The effect of hospital ownership on quality of care: evidence from England. Journal of Economic Behavior & Organization 2018;153:322-344. Download from ScienceDirect 
  • O'Hara JK, Grasic K, Gutacker N, Street A et al. Identifying positive deviants in healthcare quality and safety: a mixed methods study. Journal of the Royal Society of Medicine 2018;111(8):276-291  Download from Sage journals 
  • Rice N, Aragón MJ. The determinants of health care expenditure growth. Centre for Health Economics, University of York;CHE Research Paper 156 (PDF, 1,892kb)2018. 
  • Ride J, Kasteridis P, Gutacker N, et al. Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England. BMJ Open 2018; 8(11):e023135. Download from BMJ 
  • Swami M, Gravelle H, Scott A, Williams J. Hours worked by General Practitioners and waiting times for Primary Care. Health Economics 2018;27(10):1513-1532.Download from Wiley
  • Tosetti E, Santos R, Moscone F, Arbia G. The spatial dimension of health systems. In: Econometrics, Experimental and Quantitative Methods, Health, Education, and Welfare, Public Economics and Policy. Oxford Research Encyclopedia, Economics and Finance 2018;30p.


  • Al Quait A, Doherty P, Gutacker N, Mills J. In the modern era of percutaneous coronary intervention: Is cardiac rehabilitation engagement purely a patient or a service level decision? European Journal of Preventive Cardiology 2017;doi:10.1177/2047487317717064. Download from Sage 
  • French EB, McCauley J, Aragon M, Bakx P, Chalkley M, et al., Rice N, Skinner JS, van Doorslaer E, Ziebarth NR, Kelly E. End-of-life medical spending in last twelve months of life is lower than previously reported. Health Affairs 2017;36(7):1211-1217. Download from Health Affairs
  • Gutacker N, Bloor K, Cookson R, Gale CP, Maynard A, Pagano D, Pomar J, Bernal-Delgado E. Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold. Health Services Research 2017;52(2):863-878. Download from Wiley
  • Gutacker NStreet A. Multidimensional performance assessment of public sector organisations using dominance criteria. Health Economics 2017;doi:10.1002/hec.3554. Download from Wiley
  • Gutacker NStreet A. Use of large scale HRQoL datasets to generate individualised predictions and inform patients about the likely benefit of surgery. Quality of Life Research 2017;doi:10.1007/s11136-017-1599-0. Download from Springer
  • Kronenberg C, Doran T, Goddard M, Kendrick T, Gilbody S, Dare C, Aylott L, Jacobs R. Identifying primary care quality indicators for people with serious mental illness: a systematic review. British Journal of General Practice 2017;doi:10.3399/bjgp17X691721. Download from BJGP 
  • Li Y, Wang JL, Zhang XC, Liu D, Shi WH, Liang XF, Wu J. Effectiveness of adherence to standardized hypertension management by primary health care workers in China: a cross-sectional survey 3 years after the healthcare reform. Biomedical and Environmental Sciences 2016;29(12):915-921. Download from BES
  • Longo F, Siciliani L, Gravelle HSantos R. Do hospitals respond to rivals’ quality and efficiency? a spatial econometrics approach. Centre for Health Economics, University of York; CHE Research Paper 144 (PDF , 1,782kb) 2017.
  • Mannion R, Davies HTO, Jacobs RKasteridis P, Millar R, Freeman T. Do hospital boards matter for better, safer, patient care? Social Science & Medicine 2017;177:278-287. Download from Elsevier
  • Moran V, Jacobs R. Investigating the relationship between costs and outcomes for English mental health providers: a bi-variate multi-level regression analysis. The European Journal of Health Economics 2017;doi:10.1007/s10198-017-0915-5. Download from Springe
  • Moscelli GGravelle H, Siciliani L, Gutacker N. The effect of hospital ownership on quality of care: evidence from England. Centre for Health Economics, University of York; CHE Research Paper 145 (PDF , 1,826kb) 2017.


  • Gomes M, Gutacker N, Bojke C, Street AAddressing missing data in Patient-Reported Outcome Measures (PROMs): implications for the use of PROMs for comparing provider performance. Health Economics 2016;25(5):515-528. Download from Wiley
  • Gutacker N, Bloor K, Cookson R, Gale C, Maynard A, Pagano D, Pomar J, Bernal-Delgado E. Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold. Health Services Research 2016;early view.
  • Gutacker N, Siciliani L, Cookson R. Waiting time prioritisation: Evidence from England. Social Science & Medicine 2016;159;140-151.
  • Hall M, Laut K, Dondo TB, Alabas OA, Brogan RA, Gutacker N, Cookson R, Norman P, Timmis A, de Belder M, Ludman P F, Gale CP. Patient and hospital determinants of primary percutaneous coronary intervention in England, 2003-13. Heart 2016;102(4):313-319.
  • Martin S, Street A, Han L, Hutton J. Have hospital readmissions increased in the face of reductions in length of stay? Evidence from England. Health Policy 2016;120(1):89-99. Download from ScienceDirect 
  • Moscelli G, Siciliani L, Tonei V. Do waiting times affect health outcomes?: Evidence from coronary bypass. Social Science and Medicine 2016;161:151-159. Download from ScienceDirect


  • Cookson RGutacker N, Garcia-Armesto, S, Angulo-Pueyo E, Christiansen T, Bloor K, Bernal-Delgado E. Socioeconomic inequality in hip replacement in four European countries from 2002 to 2009 – area level analysis of hospital data. European Journal of Public Health 2015;25(suppl1):21-27. Download from Oxford journals
  • Dusheiko M, Gravelle H, Martin S, Smith PC. Quality of disease management and risk of mortality in English primary care practices. Health Services Research 2015;doi:10.1111/1475-6773.12283. 
  • Gomes M, Gutacker N, Bojke C, Street A. Addressing missing data in Patient-Reported Outcome Measures (PROMs): implications for the use of PROMs for comparing provider performance. Health Economics 2015;doi:10.1002/hec.3173. Download from Wiley
  • Gutacker N, Bloor K, Cookson R. Comparing performance of the Charlson/Deyo and Elixhauser co-morbidity indices across five European countries and three conditions. European Journal of Public Health 2015;(suppl1):15-20. Download from Oxford journals
  • Gutacker N, Bloor K, Cookson R, Garcia-Armesto S, Bernal-Delgado E. Comparing hospital performance within and across countries: an illustrative study of coronary artery bypass graft surgery in England and Spain. European Journal of Public Health 2015;25(suppl1):28-34. Download from Oxford journals
  • Gutacker NMason A, Kendrick T, Goddard MGravelle H, Gilbody S, Aylott L, Wainwright J, Jacobs R. Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis. BMJ Open 2015;5(4):e007342. Download from bmjopen
  • Gutacker NStreet A, Gomes C, Bojke C. Should English healthcare providers be penalised for failing to collect patient-reported outcome measures (PROMs)? A retrospective analysis of linked routine administrative data. Journal of the Royal Society of Medicine 2015;doi:10.1177/0141076815576700. Download from sagepub
  • Jacobs RGutacker N, Mason AGoddard MGravelle H, Kendrick T. Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data. NIHR HS & DR Journal 2015;3(16). Download from NIHR
  • Kasteridis PMason AGoddard MJacobs RSantos R, McGonigal G. The influence of primary care quality on hospital admissions for people with dementia in England: a regression analysis. PLoS One 2015;10(3):e0121506. Download from plosoneDementia Lay Summary (PDF  , 353kb),Dementia S1 Appendix (PDF  , 52kb)Dementia S2 Appendix (PDF  , 50kb)
  • Mannion R, Davies H, Freeman T, Millar R, Jacobs RKasteridis P. Overseeing oversight: governance of quality and safety by hospital boards in the English NHS. Journal of Health Services Research and Policy 2015;20:(1):1-8.
  • Vogl M, Leidl R, Plotz W, Gutacker N. Comparison of pre- and post-operative health-related quality of life and length of stay after primary total hip replacement in matched English and German patient cohorts. Quality of Life Research 2015;24(2):513-520. Download from springer


  • Aragon MJChalkley M. Understanding the differences in in-hospital mortality between Scotland and England. Centre for Health Economics, University of York; CHE Research Paper 104 (PDF  , 1,494kb), 2014.
  • Gomes M, Gutacker N, Bojke C, Street A. Addressing missing data in patient-reported outcome measures (PROMs): implications for comparing provider performance. Centre for Health Economics, University of York; CHE Research Paper 101 (PDF  , 1,619kb) 2014.
  • Gravelle HSantos RSiciliani L. Does a hospital’s quality depend on the quality of other hospitals? A spatial econometrics approach. Regional Science and Urban Economics 2014;49:203-216. Download from ScienceDirect
  • Harrison M, Dusheiko M, Sutton M, Gravelle H, Doran T, Roland M. Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study. BMJ 2014;349:g6423. 
  • Martin S, Street A, Han L, Hutton J. The impact of hospital financing on the quality of inpatient care in England. Centre for Health Economics, University of York; CHE Research Paper 105 (PDF  , 1,930kb), 2014.
  • Siciliani L, Moran V, Borowitz M. Measuring and comparing health care waiting times in OECD countries. Health Policy 2014;118(3):292-303. Download from healthpolicyjrnl 
  • Street A, Gutacker N, Bojke C, Devlin N, Daidone S. Variations in outcome and costs among NHS providers for common surgical procedures: econometric analyses of routinely collected data. National Institute for Health Research. Health Services and Delivery Research 2014:2(1). Download from NIHR and Download spreadsheet showing provider performance (MS Excel  , 175kb)


  • Ashworth M, Schofield P, Doran T, Cookson R, Sutton M, Seed P, et al. The Public Health Impact (PHI) score – a new measure of public health effectiveness for general practices in England. British Journal of General Practice 2013;63(609):291-9.
  • Fichera E, Gravelle H, Pezzino M, Sutton M. Choice of contracts for quality in health care: Evidence from the British NHS. Centre for Health Economics, University of York, CHE Research Paper 85 (PDF , 968kb) 2013.
  • Gravelle H, Santos R, Siciliani L. Does a hospital's quality depend on the quality of other hospitals? a spatial econometrics approach to investigating hospital quality competition. Centre for Health Economics, University of York; CHE Research Paper 82 (PDF , 624kb) 2013. Lay Summary 82 (PDF , 397kb)
  • Gutacker N, Bojke C, Daidone S, Devlin N, Street A. Hospital variation in patient-reported outcomes at the level of EQ-5D dimensions - Evidence from England. Medical Decision Making 2013;33(6):804-818. Download from sagepub
  • Jacobs R, Mannion R, Davies HTO, Harrison S, Konteh F, Walshe K. The relationship between organizational culture and performance in acute hospitals. Social Science and Medicine 2013;76:115-25. Download from Sciencedirect
  • Sampson C, Whitehurst D, Street AD. Do patients registered with CAM-trained GPs really use fewer health care resources and live longer? A response to Kooreman and Baars. European Journal of Health Economics 2013;14(4):703-705.
  • Smith PC, Street AD. On the uses of routine patient-reported health outcome data. Health Economics 2013;22(2):119-131.


  • Gutacker N, Bojke C, Daidone S, Devlin N, Street A. Analysing hospital variation in health outcome at the level of EQ-5D dimensions: Centre for Health Economics, University of York; CHE Research Paper 74 (PDF , 521kb) 2012.
  • Kontopantelis E, Doran T, Gravelle HSiciliani L, Sutton M, Goudie R. Pay-for-performance and influenza immunization: the impact of raising the bar in the UK Quality and Outcomes Framework. Health Services Research 2012;47(3, part 1):1117-36.
  • Pattenden J, Mason A, Lewin R. Collaborative palliative care for advanced heart failure: Outcomes and costs from the ‘Better Together’ pilot study. BMJ Supportive and Palliative Care 2012;Published Online first:4 September 2012 doi:10.1136/bmjspcare-2012-000251.


  • Castelli A, Nizalova O. Avoidable mortality: what it means and how it is measured: Centre for Health Economics, University of York; CHE Research Paper 63 (PDF  , 1,149kb)‎ 2011.
  • Cookson R. The tough test for the NHS isn’t cost but care. Parliamentary Brief 2011;13(6). Download from parliamentary brief online
  • Dusheiko M, Doran T, Gravelle H, Fullwood C, Roland M. Does higher quality of diabetes management in family practice reduce unplanned hospital admissions? Health Services Research 2011;46:27-46.
  • Dusheiko M, Gravelle H, Martin S, Rice N, Smith PC. Does better disease management in primary care reduce hospital costs? Centre for Health Economics, University of York; CHE Research Paper 65 (PDF  , 315kb)‎ 2011.
  • Dusheiko M, Gravelle H, Martin S, Rice N, Smith PC. Does disease management in primary care reduce hospital costs? Evidence from English primary care. Journal of Health Economics 2011;30(5):919-32.
  • Fleetcroft R, Cookson R, Steel N, Howe A. Correlation between prescribing quality and pharmaceutical costs in English primary care: national cross-sectional analysis. British Journal of General Practice 2011;61:554-55.
  • Marks L, Cave S, Wallace A, Mason A, Hunter DJ, Mason JM, Peckham S. Incentivising preventive services in primary care: perspectives on the use of Local Enhanced Services. Journal of Public Health 2011.