Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service

• 成果类型: Article
• 署名作者: Gaynor, Martin; Propper, Carol; Seiler, Stephan
• 署名单位: Carnegie Mellon University; University of Bristol; National Bureau of Economic Research; Imperial College London; Centre for Economic Policy Research - UK; Stanford University
• 刊物名称: AMERICAN ECONOMIC REVIEW
• ISSN/ISSBN: 0002-8282
• DOI: 10.1257/aer.20121532
• 发表日期: 2016
• 页码: 3521-3557
• 关键词: HOSPITAL CHOICE; market power; COMPETITION; care; QUALITY; demand; search; MODEL; incentives; insurance

摘要

Choice in public services is controversial. We exploit a reform in the English National Health Service to assess the effect of removing constraints on patient choice. We estimate a demand model that explicitly captures the removal of the choice constraints imposed on patients. We find that, post-removal, patients became more responsive to clinical quality. This led to a modest reduction in mortality and a substantial increase in patient welfare. The elasticity of demand faced by hospitals increased substantially post-reform and we find evidence that hospitals responded to the enhanced incentives by improving quality. This suggests greater choice can raise quality.