Market analysis and system management - Projects


1. Hospital service reconfiguration, small hospitals, mergers and closure


Project lead: Hugh Gravelle, Luigi Siciliani


Context and problem statement


Hospital service configuration (location, specialisation, and size of hospitals) may have a considerable impact on providers’ efficiency and quality and on accessibility for patients.  The analysis will provide evidence of the wider implications of hospital service configuration, with special focus on small providers, and their potential closure or merger. It will inform policy on whether small hospitals as a whole provide lower quality. If so, there may be a case to close them or merge them, and relocate patients to more distant providers.


Project aims


The project is designed to:

i) assess whether small NHS Trusts have lower quality compared to larger Trusts, where quality will be measured by hospital-level markers such as CQC rating, hospital-acquired infections, patient satisfaction,  overall mortality and by mortality rates for selected conditions (such as acute myocardial infarction (AMI), hip fracture and stroke).
ii) assess implications of reconfigurations, such as closure or a merger, for elective patients in terms of distance and quality.

 

2. Market structure, patient choice and responsiveness and efficiency


Project lead: Hugh Gravelle, Luigi Siciliani


Context and problem statement


Little is known about whether and how market structure and patient choice also affect the efficiency and productivity of hospitals and patient waiting times, a key measure of accessibility and responsiveness.  This analysis determine whether hospitals with different market structure and configuration vary in quality, efficiency, productivity and the way they make access more easily available to patients. It will also highlight whether hospitals with higher quality may experience longer wait as a result of greater choice and relocation of patients from high- to low-quality hospitals.

 

Project aims


The project research questions are (i) does market structure affect hospital efficiency, productivity, and waiting times and its distribution across hospitals and (ii) do these effects depend on the extent to which patients can exercise choice (with potentially high-quality hospitals offering longer waits and low-quality hospitals shorter ones)?

 

3. The effect of public and private ownership and management on healthcare quality


Project lead: Hugh Gravelle, Luigi Siciliani


Context and problem statement


Increasingly, the Independent (private) Sector and dedicated Treatment Centres are providing common elective procedures such as hip replacement and cataract surgery to NHS patients. This project will inform whether the NHS should change hospital configuration by further expanding contracting to either the private sector (ie the Independent Sector), and/or dedicated facilities that focus on high-volume elective care.


Project aims


The project will test for differences in hospital emergency readmissions between Acute Trusts, Independent Sector and Treatment Centres. The analysis will therefore focus on a measure of clinical quality which can be applied to all elective procedures provided by the Independent Sector and by Treatment Centres.

 

4. Market dynamics in the care homes market


Project lead: Julien Forder, Jose-Luis Fernandez


Context and problem statement


Relatively little is known about the operation of the care homes market in England. A particular issue is the sustainability of large providers in the care home sector. Understanding the financial health of providers and predicting whether there is a significant risk of bankruptcy is key to avoiding the disruption to care associated with changes in ownership and management, and possibly with the closure of a care establishment.


Project aims


The overall aim of this project is to gain a better understanding of the factors that affect (potential) changes in supply in the care homes market. In particular, we are interested in identifying and quantifying the impact of factors that might be affected by policy including competition, financial health and external factors such as local market characteristics.


This project has two main objectives:

5. The effect of substitution in social care provision on supply side dynamics


Project lead: Steve Allan


Context and problem statement


Little is known about the impact that increased provision of domiciliary care might have on the care homes market. This work will help policy makers understand the consequences of policies to promote the increase of home-based care options. In the context of tightening budgets and increased eligibility thresholds which mostly affect access to home care, this research will help us to assess the consequences for the demand for care home services.


Project aims


The main aim is to analyse the impact that the increase in home care provision may have had on supply (including entry and exit) in the care homes market.

 

6. Expenditure, skill mix, quality and outcomes in general practice: an exploratory study


Project lead: Hugh Gravelle


Context and problem statement


The project will provide policy makers with new information about the relationship between general practice expenditure, skill mix and patient outcomes. It will identify variation in expenditure per patient both with and without controlling for patient characteristics and outcomes. 

 
Project aims


The project aims are (i) to explore and summarise the cross section relationships between expenditure, skill mix, quality and outcomes and (ii) when subsequent years of data become available to investigate if the cross-section relationships are robust and if they provide evidence for causal effects.

 

7. Market structure and general practice quality


Project lead: Hugh Gravelle, Carol Propper


Context and problem statement


Patient choice of general practice is influenced by general practice quality. This project builds on earlier work to inform policy makers concerned about policies to encourage entry of new practices and new types of provider about the potential effects of market structure on quality.


Project aims


The project research question is whether practices exposed to more competition have higher quality.

 

8. Models of care with accommodation: care homes and extra care housing


Project lead: Julien Forder


Context and problem statement


Relatively little is known about the factors that facilitate or constrain the development of extra care housing provision, especially given the ‘mixed economy’ structure of the care sector. The research will help to identify barriers and enablers for extra care housing, including private, for-profit, provision.


Project aims


The project has four linked aims:

(a) To explore the availability and potential of models of care with accommodation
(b) To explore the potential for substitution with care home services
(c) To explore the role of housing with care in supporting health and providing a stable location for healthcare delivery
(d) To consider issues of funding and supply