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Essays in the Economics of Healthcare

Stoye, George; (2020) Essays in the Economics of Healthcare. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

How to provide and fund healthcare is becoming an increasingly important debate in many countries due to widespread demographic changes. This has led to a growing focus on inequalities in the amount and quality of care provided to different groups. This thesis contains three papers that examine the roles played by medical staff and institutional frameworks in explaining this variation. Throughout, I use the English National Health Service as a testbed to examine these roles, exploiting the institutional features of this universal public health system and its rich administrative data. In the first paper, I examine the extent to which individual doctors explain variation in patient outcomes. Studying consultants treating heart attack patients, I exploit within-hospital random assignment of patients to doctors, and the movement of staff between hospitals, to estimate the effect of individual doctors on patient survival. I show considerable variation in the quality of individual doctors, and examine potential improvements in patient survival from reassigning doctors across patients. In the second paper, I study the impacts of external regulation on the performance of doctors in English emergency departments. I extend a ‘bunching’ methodology commonly used in the tax literature to examine the impacts of the four-hour waiting time target that applies to all English hospitals. I show the regulation was successful in reducing waiting times and drastically reduced mortality. This shows that changes to the incentives of doctors can be successful in improving care quality. In the final paper, I examine the impact of reforms that allowed pre-existing private hospitals to enter public healthcare markets. I exploit historical locations of hospitals to instrument for potentially endogenous hospital entry. I show private hospital entry sizeably expanded the market, but led to little competition between new and existing hospitals, and therefore did not impact care quality.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Essays in the Economics of Healthcare
Event: UCL
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
Keywords: healthcare, economics, applied microeconomics, health economics, variation in care quality, health inequality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > UCL SLASH
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS
UCL > Provost and Vice Provost Offices > UCL SLASH > Faculty of S&HS > Dept of Economics
URI: https://discovery.ucl.ac.uk/id/eprint/10112940
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