Accessibility statement

Organisation and structure of health systems

Overview

Healthcare reforms granting patients’ choice over aspects of non-emergency hospital care have been introduced or extended in several countries over the last two decades. Patient choice is particularly important in healthcare systems based on a fixed-price regime of treatment reimbursement, since it paves the way for competition on quality between healthcare providers operating in the same market. Hence, choice and market structure can work as economic incentives to improve healthcare quality and potentially reduce inefficiencies in healthcare delivery. The evaluation of the effects of choice and market structure is paramount to help policy makers deliver a better performing healthcare system. Our research in this area covers:

  • the effect of market structure and choice on quality for primary care (GPs) and secondary care (hospitals)
  • testing whether and to what extent patients value quality in their choices for primary and secondary care
  • the effect of market structure and choice reforms on equity of healthcare

Contact: Hugh Gravelle

Publications

2019

  • Gravelle HLiu D, Propper C, Santos R. Spatial competition and quality: Evidence from the English family doctor market. Journal of Health Economics2019;68:102249. Download from Elsevier
  • Gutacker N, Bloor KE, Bojke C, Archer J, Walshe K. Does regulation increase the rate at which doctors leave practice? Analysis of routine hospital data in the English NHS following the introduction of medical revalidation. BMC Medicine 2019;17:33. Download from BMC
  • 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
  • Longo F, Siciliani L, Moscelli G, Gravelle H. Does hospital competition improve efficiency? The effect of the patient choice reform in England. Health Economics 2019;28(5):618-640. Download from Wiley
  • Moscelli G, Gravelle H, Siciliani L. Effects of market structure and patient choice on hospital quality for planned patients. Centre for Health Economics, University of York;CHE Research Paper 162 (PDF , 3,265kb)‌ 2019. 
  • Rachet-Jacquet LGutacker N, Siciliani L. The causal effect of hospital volume on health gains from hip replacement surgery. Centre for Health Economics, University of York; 2019.

2018

  • Bloor K, Goddard M. Public spending must improve health, not just healthcare. BMJ 2018;363:k4673. Download from BMJ 
  • Goddard M, Bloor K. Alan Maynard: A sceptical economist and his view of health care and health policy. Political Quarterly 2018;89(4):714-718. Download from Wiley 
  • Gravelle H, Liu D, Propper C, Santos R. Spatial competition and quality: evidence from the English family doctor market. Centre for Health Economics, University of York; CHE Research Paper 151 (PDF, 2,189kb) 2018. 
  • 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 Health 2018;doi:10.1093/eurpub/cky252. Download from OUP
  • Mason A, Liu D, Marks L, Davis H, Hunter D, Jehu L et al. Local authority commissioning of NHS Health Checks: A regression analysis of the first three years. Health Policy 2018; 122(9): 1035-1042. Download from Sciencedirect 
  • Morton K, Voss S, Adamson J, Baxter H, Bloor KE, Brandling J, Cowlishaw S, Doran T, Gibson A, Gutacker N, Liu D, et al. General practitioners and emergency departments (GPED): Efficient models of care. A mixed-methods study protocol. BMJ Open 2018;8(10):e024012. Download from BMJ
  • 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 
  • 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 

2017

  • Chalkley M, Siciliani L, Gravelle H. Policies towards hospital and GP competition in five European countries. Health Policy 2017;121(2):103-110. Download from Elsevier 
  • Dusheiko MA, Gravelle HSE. Choosing and booking – and attending? Impact of an electronic booking system on outpatient referrals and non-attendances. Health Economics 2017;doi: 10.1002/hec.3552. 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
  • Longo F, Luigi Siciliani, Moscelli G, Gravelle H. Does hospital competition improve efficiency? The effect of the patient choice reform in England. Centre for Health Economics, University of York;CHE Research Paper 149 (PDF , 1,874kb) Lay summary 149 (PDF , 428kb) 2017. ‌
  • Longo F, Siciliani L, Gravelle HSantos R. Do hospitals respond to rivals’ quality and efficiency? A spatial panel econometric analysis. Health Economics 2017;26(S2);38-62. Download from Wiley
  • Moscelli G, Siciliani L, Gutacker NCookson R. Socioeconomic inequality of access to healthcare: Does choice explain the gradient? Journal of Health Economics 2017;doi: 10.1016/j.jhealeco.2017.06.005. Download from Sciencedirect
  • Rodriguez Santana IChalkley M. Getting the right balance? A mixed logit analysis of the relationship between UK training doctors' characteristics and their specialties using the 2013 National Training Survey. BMJ Open 2017;7(8):e015219. Download from BMJ
  • Santos RGravelle H, Propper C. Does quality affect patients’ choice of doctor? Evidence from England. The Economic Journal 2017;127(600):445-494. Download from Wiley
  • Verzulli R, Jacobs RGoddard M. Autonomy and performance in the public sector: The experience of English NHS hospitals. European Journal of Health Economics 2017;doi: 10.1007/s10198-017-0906-6. Download from Springer

2016

  • Aragon MJ, Chalkley M, Rice N. Medical spending and hospital inpatient care in England: an analysis over time. Centre for Health Economics, University of York; CHE Research Paper 127 (PDF , 1,802kb) 2016.
  • Aragon, MJ, Chalkley, M, Rice, N. Medical spending and hospital inpatient care in England: an analysis over time. Fiscal Studies 2016;37:405-32.
  • Gravelle H, Scott A, Sivey P, Yong J. Competition, prices and quality in the market for physician consultations. Journal of Industrial Economics 2016;64(1):135-169.
  • Gutacker N, Bloor K, Cookson R, Gale C, Maynard A, Pagano D, Pomar J, Bernal-Delgado E. 2016. Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold. Health Services Research early view.
  • Gutacker N, Siciliani L, Moscelli GGravelle H. Choice of hospital: which type of quality matters? Journal of Health Economics 2016;50:230-246. 
  • 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 GGravelle H, Siciliani L. Market structure, patient choice and hospital quality for elective patients. Centre for Health Economics, University of York; CHE Research Paper 139 (PDF , 2,039kb)‌ 2016.
  • Moscelli G, Siciliani L, Gutacker NGravelle H. Location, quality and choice of hospital: Evidence from England 2002/3-2012/13. Centre for Health Economics, University of York;CHE Research Paper 123 (PDF , 3,144kb) 2016.
  • Moscelli G, Siciliani L, Gutacker NGravelle H. Location, quality and choice of hospital: Evidence from England 2002–2013. Regional Science and Urban Economics 2016;60:112-124. Download from Elsevier
  • Rodgers M, Thomas S, Harden M, Parker G, Street A, Eastwood A. Developing a methodological framework for organisational case studies: a rapid review and consensus development process. Health Services and Delivery Research 2016;4(1). Download from NIHR

2015

  • Dalton J, Chambers D, Harden M, Street A, Parker G, Eastwood A. Service user engagement and health service reconfiguration: a rapid evidence synthesis. Health Services and Delivery Research 2015;3(17). Download from NIHR
  • Goddard M. Competition in healthcare: Good, bad or ugly? International Journal of Health Policy and Management 2015;doi:10.15171/ijhpm.2015.144.
  • Gutacker NSiciliani LMoscelli G, Gravelle H. Do patients choose hospitals that improve their health? Centre for Health Economics, University of York;CHE Research Paper 111 (PDF  , 3,600kb) 2015.
  • Moscelli GSiciliani LGutacker N, Cookson R. Socioeconomic inequality of access to healthcare: Does patients’ choice explain the gradient? Evidence from the English NHS. Centre for Health Economics, University of York;CHE Research Paper 112 (PDF  , 2,144kb) 2015.
  • Rodríguez-Santana I, Chalkley M. The socioeconomic and demographic characteristics of United Kingdom junior doctors in training across specialities. Centre for Health Economics, University of York;CHE Research Paper 119 (PDF , 1,676kb) 2015.
  • Santos RGravelle H, Propper C. Does quality affect patients’ choice of doctor? Evidence from the UK. The Economic Journal 2015;doi:10.1111/ecoj.12282.

2014

  • Brekke KR, Gravelle H, Siciliani L, Straume OR. Patient choice, mobility and competition among health care providers. In: Levaggi R, Montefioro M (eds). Health Care Provision and Patient Mobility. Vol.12. Springer;2014 pp.1-26. 
  • Dusheiko M. Patient choice and mobility in the UK health system: internal and external markets. In : Levaggi R, Montefioro M (eds). Health Care Provision and Patient Mobility. Vol.12. Springer;2014 pp.81-132.
  • Gravelle HMoscelli G, Santos RSiciliani L. Patient choice and the effects of hospital market structure on mortality for AMI, hip fracture and stroke patients. Centre for Health Economics, University of York;CHE Research Paper 106 (PDF  , 1,980kb) 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.

2013

 

  • 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.
  • 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)
  • Gravelle H, Scott A, Sivey P, Yong J. Competition, prices, and quality in the market for physician consultations. Centre for Health Economics, University of York;CHE Research Paper 89 (PDF , 566kb) 2013.
  • Santos R, Gravelle H, Propper C. Does quality affect patients’ choice of doctor? Evidence from the UK. Centre for Health Economics, University of York; CHE Research Paper 88 (PDF , 1,782kb) 2013.
  • Street A. An overview of competition in UK health care. In: Competition in UK health care: reflections on an expert workshop. Eds. Charlesworth A, Kelly E. Institute for Fiscal Studies and Nuffield Trust research report, December 2013

2012

  • Cookson R, Dawson D. Hospital competition and patient choice in publicly funded health care. In: Jones AM, editor. The Elgar Companion to Health Economics (2nd Edition) Cheltenham: Edward Elgar;2012.
  • 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.
  • Gravelle HSantos R, Siciliani L, Goudie R. Hospital quality competition under fixed prices: Centre for Health Economics, University of York, CHE Research Paper 80 (PDF , 1,256kb) 2012. Lay Summary 80 (PDF  , 310kb)

2011

  • Chalkley M, Stewart G. Trade liberalisation, market structure and the incentive to merge. The World Economy 2011;34(8):1327-47.
  • Cookson R, Laudicella M. Effects of Health Reform on Health Care Inequalities - Final Report. NIHR SDO Programme - London.