114 results found
Cookson R, Propper C, Asaria M, et al., Socioeconomic inequalities in health care in England, Fiscal Studies, ISSN: 1475-5890
This paper reviews what is known about socioeconomic inequalities in health care in England, with particular attention to inequalities relative to need that may be considered unfair (“inequities”). We call inequalities of 5% or less between most and least deprived socioeconomic quintile groups “slight”; inequalities of 6-15% “moderate”, and inequalities of > 15% “substantial”. Overall public health care expenditure is substantially concentrated on poorer people. At any given age, poorer people are more likely to see their family doctor, have a public outpatient appointment, visit accident and emergency, and stay in hospital for publicly funded inpatient treatment. After allowing for current self-assessed health and morbidity, there is slight pro-rich inequity in combined public and private medical specialist visits but not family doctor visits. There are also slight pro-rich inequities in overall indicators of clinical process quality and patient experience from public health care, substantial pro-rich inequalities in bereaved people’s experiences of health and social care for recently deceased relatives, and mostly slight but occasionally substantial pro-rich inequities in the use of preventive care (e.g. dental checkups, eye tests, screening and vaccination) and a few specific treatments (e.g. hip and knee replacement). Studies of population health care outcomes (e.g. avoidable emergency hospitalisation) find substantial pro-rich inequality after adjusting for age and sex only. These findings are all consistent with a broad economic framework that sees health care as just one input into the production of health over the lifecourse, alongside many other socioeconomically patterned inputs including environmental factors (e.g. living and working conditions), consumption (e.g. diet, smoking), self care (e.g. seeking medical information) and informal care (e.g. support from family and friends).
Santos R, Gravelle H, Propper C, 2017, Does Quality Affect Patients’ Choice of Doctor? Evidence from England, The Economic Journal, Vol: 127, Pages: 445-494, ISSN: 0013-0133
Britton J, Propper C, 2016, Teacher pay and school productivity: Exploiting wage regulation, Journal of Public Economics, Vol: 133, Pages: 75-89, ISSN: 0047-2727
Burgess S, Propper C, Tominey E, 2016, Incentives in the Public Sector: Evidence from a GovernmentAgency, Economic Journal, ISSN: 1468-0297
We study the impact of team-based performance pay in a major UK government agency, thepublic employment service. The scheme covered quantity and quality targets, measured withvarying degrees of precision. We use unique data from the agency’s performancemanagement system and personnel records, linked to local labour market data. We show thaton average the scheme had no significant effect but had a substantial positive effect in smallteams, fitting an explanation combining free riding and peer monitoring. We also show thatthe impact was greater on better-measured quantity outcomes than quality outcomes. Thescheme was very cost effective in small offices.
Gaynor M, Propper C, Seiler S, 2016, Free to Choose? Reform, Choice, and Consideration Sets in the English National Health Service, American Economic Review, Vol: 106, Pages: 3521-3557, ISSN: 0002-8282
Janke K, Propper C, Shields MA, 2016, Assaults, murders and walkers: The impact of violent crime on physical activity, Journal of Health Economics, Vol: 47, Pages: 34-49, ISSN: 0167-6296
Bloom N, Propper C, Seiler S, et al., 2015, The Impact of Competition on Management Quality: Evidence from Public Hospitals, The Review of Economic Studies, Vol: 82, Pages: 457-489, ISSN: 0034-6527
Feng Y, Pistollato M, Charlesworth A, et al., 2015, Association between market concentration of hospitals and patient health gain following hip replacement surgery., J Health Serv Res Policy, Vol: 20, Pages: 11-17
OBJECTIVES: To assess the association between market concentration of hospitals (as a proxy for competition) and patient-reported health gains after elective primary hip replacement surgery. METHODS: Patient Reported Outcome Measures data linked to NHS Hospital Episode Statistics in England in 2011/12 were used to analyse the association between market concentration of hospitals measured by the Herfindahl-Hirschman Index (HHI) and health gains for 337 hospitals. RESULTS: The association between market concentration and patient gain in health status measured by the change in Oxford Hip Score (OHS) after primary hip replacement surgery was not statistically significant at the 5% level both for the average patient and for those with more than average severity of hip disease (OHS worse than average). For 12,583 (49.1%) patients with an OHS before hip replacement surgery better than the mean, a one standard deviation increase in the HHI, equivalent to a reduction of about one hospital in the local market, was associated with a 0.104 decrease in patients' self-reported improvement in OHS after surgery, but this was not statistically significant at the 5% level. CONCLUSIONS: Hospital market concentration (as a proxy for competition) appears to have no significant influence (at the 5% level) on the outcome of elective primary hip replacement. The generalizability of this finding needs to be investigated.
Sayal K, Washbrook E, Propper C, 2015, Childhood behavior problems and academic outcomes in adolescence: longitudinal population-based study., J Am Acad Child Adolesc Psychiatry, Vol: 54, Pages: 360-8.e2
OBJECTIVE: To investigate the impact of increasing levels of inattention, hyperactivity/impulsivity, and oppositional/defiant behaviors at age 7 years on academic achievement at age 16 years. METHOD: In a population-based sample of 7-year-old children in England, information was obtained about inattention, hyperactivity/impulsivity, and oppositional/defiant behaviors (using parent and teacher ratings) and the presence of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders (DBDs). After adjusting for confounder variables, their associations with academic achievement in national General Certificate of Secondary Education (GCSE) examinations (using scores and minimum expected school-leaving qualification level [5 "good" GCSEs]) at age 16 years were investigated (N = 11,640). RESULTS: In adjusted analyses, there was a linear association between each 1-point increase in inattention symptoms and worse outcomes (2- to 3-point reduction in GCSE scores and 6% to 7% (10%-12% with teacher ratings) increased likelihood of not achieving 5 good GCSEs). ADHD was associated with a 27- to 32-point reduction in GCSE scores and, in boys, a more than 2-fold increased likelihood of not achieving 5 good GCSEs. In boys, oppositional/defiant behaviors were also independently associated with worse outcomes, and DBDs were associated with a 19-point reduction in GCSE scores and a 1.83-increased likelihood of not achieving 5 good GCSEs. CONCLUSION: Across the full range of scores at a population level, each 1-point increase in inattention at age 7 years is associated with worse academic outcomes at age 16. The findings highlight long-term academic risk associated with ADHD, particularly inattentive symptoms. After adjusting for inattention and ADHD respectively, oppositional/defiant behaviors and DBDs are also independently associated with worse academic outcomes.
Farrell L, Hollingsworth B, Propper C, et al., 2014, The socioeconomic gradient in physical inactivity: evidence from one million adults in England., Soc Sci Med, Vol: 123, Pages: 55-63
Understanding the socioeconomic gradient in physical inactivity is essential for effective health promotion. This paper exploits data on over one million individuals (1,002,216 people aged 16 and over) in England drawn from the Active People Survey (2004-11). We identify the separate associations between a variety of measures of physical inactivity with education and household income. We find high levels of physical inactivity. Further, both education and household income are strongly associated with inactivity even when controlling for local area deprivation, the availability of physical recreation and sporting facilities, the local weather and regional geography. Moreover, the gap in inactivity between those living in high and low income households is already evident in early adult life and increases up until about age 85. Overall, these results suggest that England is building up a large future health problem and one that is heavily socially graded.
Johnston D, Propper C, Pudney S, et al., 2014, CHILD MENTAL HEALTH AND EDUCATIONAL ATTAINMENT: MULTIPLE OBSERVERS AND THE MEASUREMENT ERROR PROBLEM, Journal of Applied Econometrics, Vol: 29, Pages: 880-900, ISSN: 0883-7252
Johnston DW, Propper C, Pudney SE, et al., 2014, The income gradient in childhood mental health: all in the eye of the beholder?, Journal of the Royal Statistical Society: Series A (Statistics in Society), Vol: 177, Pages: 807-827, ISSN: 0964-1998
McCormack J, Propper C, Smith S, 2014, HERDING CATS? MANAGEMENT AND UNIVERSITY PERFORMANCE, ECONOMIC JOURNAL, Vol: 124, Pages: F534-F564, ISSN: 0013-0133
Washbrook E, Gregg P, Propper C, 2014, A decomposition analysis of the relationship between parental income and multiple child outcomes, Journal of the Royal Statistical Society: Series A (Statistics in Society), Vol: 177, Pages: 757-782, ISSN: 0964-1998
Gaynor M, Moreno-Serra R, Propper C, 2013, Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service, AMERICAN ECONOMIC JOURNAL-ECONOMIC POLICY, Vol: 5, Pages: 134-166, ISSN: 1945-7731
Howe LD, Lawlor DA, Propper C, 2013, Trajectories of socioeconomic inequalities in health, behaviours and academic achievement across childhood and adolescence, JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, Vol: 67, Pages: 358-364, ISSN: 0143-005X
Janke KM, Propper C, Shields MA, 2013, Does Violent Crime Deter Physical Activity?, IZA Discussion Paper
Propper C, Venables M-A, 2013, An assessment of Labours record on health and healthcare, OXFORD REVIEW OF ECONOMIC POLICY, Vol: 29, Pages: 203-226, ISSN: 0266-903X
Scholder SVHK, Smith GD, Lawlor DA, et al., 2013, Child height, health and human capital: Evidence using genetic markers, EUROPEAN ECONOMIC REVIEW, Vol: 57, Pages: 1-22, ISSN: 0014-2921
Washbrook E, Propper C, Sayal K, 2013, Pre-school hyperactivity/attention problems and educational outcomes in adolescence: prospective longitudinal study., Br J Psychiatry, Vol: 203, Pages: 265-271
BACKGROUND: High levels of attentional and hyperactivity problems in school-aged children, even if subthreshold for attention-deficit hyperactivity disorder (ADHD), are associated with academic under-achievement. Few large-scale, community-based studies have investigated the relationship between pre-school and adolescence. AIMS: To investigate whether pre-school hyperactivity/inattention and conduct problems are independently associated with academic outcomes at age 16. METHOD: Data from the prospective, population-based Avon Longitudinal Study of Parents and Children (ALSPAC) were used. After adjusting for a broad range of confounder variables, the associations between parent-rated hyperactivity/inattention and conduct problems measured at age 3 and academic outcomes at age 16 (national General Certificate of Secondary Education (GCSE) examination results) were investigated (n = 11 640). RESULTS: Both early hyperactivity/inattention and conduct problems had negative effects on academic outcomes. In adjusted analyses, abnormal hyperactivity/inattention scores were associated with reductions of ten GCSE points in boys. Borderline and abnormal conduct problem scores were associated with reductions of 9-10 and 12-15 points respectively. CONCLUSIONS: Pre-school hyperactivity/inattention and conduct problems carry risk of worse academic outcomes at 16.
Gaynor M, Laudicella M, Propper C, 2012, Can governments do it better? Merger mania and hospital outcomes in the English NHS, JOURNAL OF HEALTH ECONOMICS, Vol: 31, Pages: 528-543, ISSN: 0167-6296
Gaynor M, Moreno-Serra R, Propper C, 2012, Can competition improve outcomes in UK health care? Lessons from the past two decades, JOURNAL OF HEALTH SERVICES RESEARCH & POLICY, Vol: 17, Pages: 49-54, ISSN: 1355-8196
Gaynor MS, Propper C, Seiler S, 2012, Free to Choose? Reform and Demand Response in the English National Health Service
Gaynor MS, Propper C, Seiler S, 2012, Free to Choose? Reform and Demand Response in the Englishnational Health Service
Propper C, 2012, Competition, incentives and the English NHS, HEALTH ECONOMICS, Vol: 21, Pages: 33-40, ISSN: 1057-9230
Propper C, Leckie G, 2012, Increasing Competition Between Providers in Health Care Markets: The Economic Evidence, The Oxford Handbook of Health Economics, ISBN: 9780191743719
© Oxford University Press 2011. All rights reserved.This article scrutinizes the empirical literature on competition between providers and finds that the outcomes are highly varied, and that competition generates winners and losers among patients as well as providers. It examines the theoretical and empirical economic evidence on the effect of greater competition between providers in health care markets. Most of the evidence focuses on a narrow set of outcomes, primarily the effect of competition on prices and quality of health care, sometimes with a focus on winners and losers. It discusses the impact of centrally fixed prices on competition and examines the role of information in increasing competition is also discussed. It examines the effects of using centrally set prices. This article concludes raising some issues that seem to be pertinent for policymakers interested in increasing competition in their health care systems.
Propper C, Wilson D, 2012, The use of performance measures in health care systems, The Elgar Companion to Health Economics, Second Edition, Pages: 350-358, ISBN: 9781849802673
Scholder SVHK, Smith GD, Lawlor DA, et al., 2012, The effect of fat mass on educational attainment: Examining the sensitivity to different identification strategies, ECONOMICS & HUMAN BIOLOGY, Vol: 10, Pages: 405-418, ISSN: 1570-677X
Bloom N, Cooper Z, Gaynor M, et al., 2011, In defence of our research on competition in England's National Health Service, LANCET, Vol: 378, Pages: 2064-2065, ISSN: 0140-6736
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