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Landscape archaeology --- Agriculture, Ancient --- Romans --- Archéologie du paysage --- Agriculture ancienne --- Romains --- Land use --- Agriculture --- Römerzeit. --- Villa rustica. --- Landwirtschaft. --- Infrastruktur. --- Agriculture. --- Classical antiquities. --- Land use. --- Trier (Germany) --- Trier --- Germany --- Rome (Empire). --- Antiquities, Roman. --- Archéologie du paysage
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The impacts of choice in public services are controversial. We exploit a reform in the English National Health Service to assess the impact of relaxing constraints on patient choice. We estimate a demand model to evaluate whether increased choice increased demand elasticity faced by hospitals with regard to clinical quality and waiting time for an important surgical procedure. We find substantial impacts of the removal of restrictions. Patients became more responsive to clinical quality. Sicker patients and better informed patients were more affected. We leverage our model to calculate potential benefits. We find increased demand responsiveness led to a significant reduction in mortality and an increase in patient welfare. The elasticity of demand faced by hospitals increased post-reform, giving hospitals potentially large incentives to improve their quality of care and find suggestive evidence that hospitals responded strongly to the enhanced incentives due to increased demand elasticity. The results suggests greater choice can enhance quality.
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In this paper we examine the causal impact of competition on management quality. We analyze the hospital sector where geographic proximity is a key determinant of competition, and English public hospitals where political competition can be used to construct instrumental variables for market structure. Since almost all major English hospitals are government run, closing hospitals in areas where the governing party has a small majority is rare due to fear of electoral punishment. We find that management quality - measured using a new survey tool - is strongly correlated with financial and clinical outcomes such as survival rates from emergency heart attack admissions (AMI). More importantly, we find that higher competition (as indicated by a greater number of neighboring hospitals) is positively correlated with increased management quality, and this relationship strengthens when we instrument the number of local hospitals with local political competition. Adding another rival hospital increases the index of management quality by one third of a standard deviation and leads to a 10.7% reduction in heart-attack mortality rates.
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The impacts of choice in public services are controversial. We exploit a reform in the English National Health Service to assess the impact of relaxing constraints on patient choice. We estimate a demand model to evaluate whether increased choice increased demand elasticity faced by hospitals with regard to clinical quality and waiting time for an important surgical procedure. We find substantial impacts of the removal of restrictions. Patients became more responsive to clinical quality. Sicker patients and better informed patients were more affected. We leverage our model to calculate potential benefits. We find increased demand responsiveness led to a significant reduction in mortality and an increase in patient welfare. The elasticity of demand faced by hospitals increased post-reform, giving hospitals potentially large incentives to improve their quality of care and find suggestive evidence that hospitals responded strongly to the enhanced incentives due to increased demand elasticity. The results suggests greater choice can enhance quality.
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In this paper we examine the causal impact of competition on management quality. We analyze the hospital sector where geographic proximity is a key determinant of competition, and English public hospitals where political competition can be used to construct instrumental variables for market structure. Since almost all major English hospitals are government run, closing hospitals in areas where the governing party has a small majority is rare due to fear of electoral punishment. We find that management quality - measured using a new survey tool - is strongly correlated with financial and clinical outcomes such as survival rates from emergency heart attack admissions (AMI). More importantly, we find that higher competition (as indicated by a greater number of neighboring hospitals) is positively correlated with increased management quality, and this relationship strengthens when we instrument the number of local hospitals with local political competition. Adding another rival hospital increases the index of management quality by one third of a standard deviation and leads to a 10.7% reduction in heart-attack mortality rates.
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Don de Nicolas Schröder
History of Belgium and Luxembourg --- German Speaking Community --- Deutschsprachige Gemeinschaft Belgiens --- Histoire --- Eupen-Malmédy-Saint-Vith (Belgique ; région) --- C8 --- Oostkantons --- Nederlanden --- Oostenrijkse Nederlanden --- Ideologie en politiek --- anno 1940-1949 --- anno 1950-1959 --- anno 1960-1969 --- anno 1970-1979 --- anno 500-1499 --- anno 1-499 --- Germans --- Social conditions --- Deutschsprachige Gemeinschaft (Eupen, Belgium) --- History. --- Belgium --- Ethnic relations. --- Politics and government. --- C6 --- geschiedenis --- History --- Belgique --- Politics and government --- Politique et gouvernement --- Social conditions. --- Cities and towns --- Eupen-Malmedy-Saint-Vith (Belgium ; region) --- To 1500 --- Villages --- Castles --- Textile fabrics --- 16th century --- 17th century --- 18th century --- Pots --- Cadastres --- Geschiedenis van België en Luxemburg --- anno 1910-1919 --- anno 1920-1929 --- anno 1930-1939 --- Duitstalige Gemeenschap --- Histoire. --- Germans--Belgium --- Liège (Belgium : Province)--History --- Communauté germanophone --- 1945-1973 --- Deutschsprachige Gemeinschaft Belgiens.
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