Increased competition in the NHS has not harmed deprived neighbourhoods: Study

Centre for Health EconomicsOct 10 2011

Increased competition in the NHS has not harmed deprived neighbourhoods, according to new research from the Centre for Health Economics (CHE), University of York.

Major pro-competition reforms were introduced into the English NHS during the 2000s, alongside accelerated spending growth.  The 'Blair/Brown' reforms introduced by the Labour Government aimed to reduce hospital waiting times and improve quality.  However, critics predicted that competition would undermine equity by encouraging NHS hospitals to 'cherry-pick' profitable patients and avoid socio-economically disadvantaged patients who are less healthy and more difficult to treat.

Using data on all NHS hospital patients in England, CHE researchers examined whether increased competition led to increased socio-economic inequality of access to health care.

The team found no substantial change in socio-economic patterns of hospital use from 2001/02 to 2008/09, either overall or for a basket of common hospital services including hip, cataract, heart and gastroscopy procedures.  In fact, overall inpatient admission rates rose slightly faster in deprived neighbourhoods while need for hospital care as measured by disease prevalence changed at the same rate.

The team also looked specifically at the impact of competition, as opposed to NHS expenditure growth and other factors.  They found that increased competition from 2006 did not undermine socio-economic equity in health care and, if anything, may have slightly increased use of elective inpatient services in poorer neighbourhoods.

Finally, using hip replacement as an example, the study showed that NHS hospitals have little incentive to discriminate against hip replacement patients from poorer areas, though there may be incentives to avoid very elderly and very sick patients likely to have long lengths of stay.

Project lead Dr Richard Cookson said: "Our findings echo similar results from previous research into the Conservative 'internal market' reforms of the NHS in the 1990s, all of which points to little change in socio-economic equity in health care over the past two decades.  Neither Conservative nor Labour attempts to introduce competition into the NHS appear to have had any measurable effect on socio-economic equity in health care."