Hoe, Thomas P; (2018) Essays on the Economics of Health Care Provision. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Health care provision is a major sector of the economy in all developed economies. Productivity in these settings impacts levels of taxation and insurance costs, and for patients can often mean the difference between life and death. This thesis studies the economics of health care production in a hospital setting. I use uniquely rich administrative data from England over the period 2006 to 2013. I present three new findings. First, the number of patients admitted to hospital ('crowding') has an adverse impact on the quality of care delivered in hospitals. This features in Chapter 2, where I show that more crowding, despite its adverse effects, can benefit consumers because it allows for shorter waiting times for hospital appointments. Second, the number of days a patient spends in a hospital inpatient department has a material impact on the likelihood that a patient subsequently returns to hospital for further treatment ('readmission'). I quantify this relationship in Chapter 3 and argue that it partially explains the increases in readmissions that has accompanied the adoption of price regulation through prospective payment systems. Third, policies that constrain the amount of time patients can spend in a hospital emergency department can induce cost-effective reductions in patient mortality. This finding stems from Chapter 4, which is joint work with Jonathan Gruber and George Stoye, where we use an innovative application of 'bunching' techniques to study a landmark policy in emergency departments.

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