Carol Propper

Income-related inequalities in health: some international comparisons

This paper presents evidence on income-related inequalities in self-assessed health in nine industrialized countries. Health interview survey data were used to construct concentration curves of self-assessed health, measured as a latent variable. Inequalities in health favoured the higher income groups and were statistically significant in all countries. Inequalities were particularly high in the United States and the United Kingdom. Amongst other European countries, Sweden, Finland and the former East Germany had the lowest inequality. Across countries, a strong association was found between inequalities in health and inequalities in income.

Equity in the delivery of health care in Europe and the US

This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives.

Equity in the finance of health care: some further international comparisons

This paper presents further international comparisons of progressivity of health care financing systems. The paper builds on the work of Wagstaff et al. [Wagstaff, A., van Doorslaer E., et al., 1992. Equity in the finance of health care: some international comparisons, Journal of Health Economics 11, pp. 361-387] but extends it in a number of directions: we modify the methodology used there and achieve a higher degree of cross-country comparability in variable definitions; we update and extend the cross-section of countries; and we present evidence on trends in financing mixes and progressivity.

Does competition between hospitals improve the quality of care? Hospital death rates and the NHS internal market

Payer-driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. Using data that until 1999 was not publicly available in any form on hospital level death rates, we find that the relationship between competition and quality of care appears to be negative. Greater competition is associated with higher death rates, controlling for patient mix and other observed characteristics of the hospital and the catchment area for its patients. However, the estimated impact of competition is small. JEL Classification: I1, L8, H4

Competition and Quality: Evidence from the NHS Internal Market 1991-9

Payer-driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. We exploit differences in competition over time and space to identify the impact of competition. Using data on mortality as a measure of hospital quality and exploiting the policy change during the 1990s, we find that the relationship between competition and quality of care appears to be negative.

The demand for private health care in the UK

Policy change has eroded the entitlement of UK residents to free state-provided health care, with a resulting rise in the use of the private sector. This paper examines the choice between public and private health care. It models the use of private health care as a function of its costs and benefits relative to state care and no care. The results indicate a difference between users of private care and other care, and the importance of past use as a predictor of current use. But they also show considerable movement between the public and private sectors, indicating a complex relationship in public and private sector use.

Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study

Aims  To investigate socio‐economic inequalities in diabetes complications, and to examine factors that may explain these differences.

The Disutility of Time Spent on the United Kingdom's National Health Service Waiting Lists

Waiting lists are central to the allocation of medical care in the British National Health Service. But there have been few attempts to cost these lists. This paper argues that these lists have a cost to consumers. This cost cannot be estimated from the observed actions of demanders of care. A method of contingent valuation is proposed and used as a means of obtaining data to derive an estimate of this cost. The paper presents the methodology and derives a set of estimates of the disutility of time spent on a waiting list for nonurgent treatment.

Contingent Valuation of Time Spent on NHS Waiting Lists

This paper derives estimates of the consumer-bourne costs of waiting lists for nonurgent medical care. The methodology used is contingent valuation. The paper examines the use of this methodology and presents the experimental context and the estimates derived. The estimates indicate the average valuation of a month spent on a waiting list for nonurgent care is approximately 40 pounds, but also show that there exist significant interpersonal differences in valuations. Copyright 1990 by Royal Economic Society.

Do doctors respond to financial incentives? UK family doctors and the GP fundholder scheme

Abstract The 1991 reforms to the UK NHS created a group of buyers of hospital care from amongst primary care physicians. The implementation of the reforms was such that these buyers had incentives to increase their use of hospital services prior to entering the scheme in order to inflate their budgets. It has been argued that non-financial motives would limit such behaviour. The paper shows that these health care providers did respond to the financial incentives offered by the scheme, increasing hospital-based activity prior to entry, and so inflating their budgets upwards for the duration of the fundholding scheme.