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Patient Choice, Mobility and Competition Among Health Care Providers

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Health Care Provision and Patient Mobility

Part of the book series: Developments in Health Economics and Public Policy ((HEPP,volume 12))

Abstract

Policymakers are increasingly designing policies that encourage patient choice and therefore mobility across providers. Since prices are regulated (fixed) in most countries, providers need to compete on quality to attract patients. This chapter reviews the current theoretical and empirical literature on patient choice and quality competition in health markets. The theoretical literature identifies key factors affecting incentives to provide quality. These include: altruistic motives, cost structure, number of providers, demand responsiveness, GP gatekeeping, degree of specialization, profit constraints and soft budgets. We also review the theoretical literature on choice across different countries (e.g. within the EU) or regions within the same countries. The chapter reviews selected empirical studies that investigate whether demand responds to quality and waiting times, the role of patient’s mobility and the effect of competition on quality.

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Notes

  1. 1.

    See Gaynor (2006) and Gaynor and Town (2011) for reviews of the literature on hospital competition.

  2. 2.

    See Gaynor (2006), Gaynor and Town (2011), and Propper (2012), for a detailed review of the literature. When prices are variable and endogenously determined, the evidence from the US finds a positive relationship between competition and quality in Sari (2002), Gowrisankaran and Town (2003), and Abraham et al. (2007). However, in England Propper et al. (2004) and Burgess et al. (2008) find a significant (though small) negative relationship for a period in which hospital prices were not centrally regulated.

  3. 3.

    Bevan and Skellern (2011) and OHE (2012) have also reviewed these studies and the three most recent ones have been subject of an exchange in The Lancet (Pollock et al. 2011a, b; Bloom et al. 2011b, 2012).

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Author information

Authors and Affiliations

  1. Department of Economics, Norwegian School of Economics, Helleveien 30, 5045, Bergen, Norway

    Kurt R. Brekke

  2. Centre for Health Economics, University of York, Heslington, York, UK

    Hugh Gravelle

  3. Department of Economics and Related Studies, and Centre for Health Economics, University of York, Heslington, York, UK

    Luigi Siciliani

  4. Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057, Braga, Portugal

    Odd Rune Straume

  5. Department of Economics, University of Bergen, Bergen, Norway

    Odd Rune Straume

Authors
  1. Kurt R. Brekke
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  2. Hugh Gravelle
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  3. Luigi Siciliani
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  4. Odd Rune Straume
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Corresponding author

Correspondence to Luigi Siciliani .

Editor information

Editors and Affiliations

  1. Department of Economics and Management, University of Brescia, Brescia, Italy

    Rosella Levaggi

  2. Department of Economics, University of Genoa, Genova, Italy

    Marcello Montefiori

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Brekke, K.R., Gravelle, H., Siciliani, L., Straume, O.R. (2014). Patient Choice, Mobility and Competition Among Health Care Providers. In: Levaggi, R., Montefiori, M. (eds) Health Care Provision and Patient Mobility. Developments in Health Economics and Public Policy, vol 12. Springer, Milano. https://doi.org/10.1007/978-88-470-5480-6_1

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