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Home » Research Projects » Historical and Longitudinal Small Area analysis of the Effects of Market-Orientated reform on Equity of Access to NHS Care from 1991-2001

This little patient went to market…

Has market-oriented reform in the NHS helped or harmed equity of access for patients?

One of the things that is said to be ‘public’ about public services is that such services should be equally available to everyone who needs them. The reality is often very different, with accessibility affected by geography (‘postcode lotteries’), class and race bias. Students of public services have been intensely concerned with such questions for many years, and much has been written about equality of access to education. But we know rather less about variations of access to health care, and what affects those variables.

This study aims to explore the effects of two major market-oriented reforms introduced in the UK national health service in the 1990s (general practitioner fund-holding and ‘internal market’ hospital competition) on socio-economic inequalities in the use of some specialist NHS services, by introducing a large dataset covering the decade from 1991 to 2001 and developing the methodology to analyse it.

What the research means for policy-makers and the wider community

Research Methods

The study will assemble a new longitudinal small area dataset covering England over the decade from 1991/2 to 2001/2. The research will focus on elective total hip replacements and revascularisations and examine equality of access in those procedures.

In determining the effects of market-oriented reform on access to these practices, the study will take account of geographical variations in need, supply and other factors that influence use of care, changes in demographics and changes in geographical boundaries.

The study will track variations in use by the populations of over 8,000 small areas (electoral wards) in England over decade, compiling a dataset that analyzes utilisation by area and also tracks variations in socio-economic status, GP fund-holding penetration and hospital competition for each area over time.

Project Outputs and Related Webpages

Project Poster 2009

Article in JPART Special Issue on Incentives Richard Cookson, Mark Dusheiko Geoffrey Hardman and Stephen Martin ‘Competition and Inequality: Evidence from the English National Health Service 1991–2001’ July 2010

Research Team

Richard Cookson

Richard Cookson

Richard Cookson is a Senior Lecturer in Social Policy at the University of York and Visiting MRC Research Fellow at the Centre for Health Economics. He has published widely on health equity and health care reform.

Email: rc503@york.ac.uk

Mark Dusheiko

Mark Dusheiko

Mark Dusheiko is a Research Fellow at the National Primary Care Research and Development Centre at the University of York.

Email: mad105@york.ac.uk

Stephen Martin

Stephen Martin

Stephen Martin is a Research Fellow at the Department of Economics and Related Studies at the University of York.

Alan Maynard

Alan Maynard

Alan Maynard is Professor of Health Economics and Director of the York Health Policy Group at the University of York.

Email: akm3@york.ac.uk