This thesis analyses the issue of competition for hospital services, introduced in the UK by the NHS reform in 1991. The work is structured around two main questions: whether efficient contracts for hospital services can be devised by economic theory, and whether efficiency and productivity have actually changed since the introduction of the reform. For data reasons, the focus of this second part is on Scotland only. Chapter 1 is a general introduction to the work. Chapter 2 performs the theoretical analysis. The economic literature on hospital contracts in discussed first, and a model is then developed which takes into consideration the existence of waiting time and its effect on patients’ utility. The conclusions cast some doubts on the possibility of defining an optimal contract, and emphasise the possible drawbacks of the prospective payment systems suggested by the reform. Chapters 3 to 5 are devoted to the empirical analysis. As one of the main aims of the reform was to improve efficiency, this is the focus of the research, and the approach is the estimation of production frontiers, reviewed in Chapter 3. The data are a sample of 53 acute hospitals in Scotland between 1991/92 and 1996/97 (the beginning and the end of the reform). Two methods of estimation are used because of their complementarity: the non- parametric DEA and Malmquist indexes are the subject of Chapter 4; the econometric estimation of stochastic distance functions is in Chapter 5. The results show an improvement in productivity whereas the improvement in technical efficiency is controversial and not related to the working of the reform (represented by hospitals’ trust status). Furthermore, a change in the technology of production and in what hospitals produce is found, which casts some doubts on the beneficial effects of the reform. The general conclusions are in Chapter 6.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:247437 |
| Date | January 2001 |
| Creators | Ferrari, Alessandra |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/105013/ |
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