Health Management and Policy Alert

How has the role of the private sector changed in UK health care?

Nuffield Trust -
This long read reveals that, since the pandemic, there has been a 30% increase in the number of people paying out of their own pocket for hospital care across the UK’s four countries. The authors warn that this may be being forced by a lack of timely access to NHS provision rather than a planned extension of the self-pay private sector.

• Briefing
• Nuffield Trust - press release

Assessing the biosimilar void: achieving sustainable levels of biosimilar competition in Europe

IQVIA Institute for Human Data Science - 

While biosimilar competition in Europe has played a vital role in achieving significant healthcare savings and expanding patient access to key medicines, the changing nature of future loss of exclusivity (LoE) events means that competition, and by extension savings, is not always guaranteed. This report provides a timely view of the factors underlying the changing level of biologic pipeline activity in Europe, highlighting classes of biologics that are at risk of failing to attract biosimilar competition, a concept called “the biosimilar void.” This report also aims to quantify the potential impact of the biosimilar void on healthcare system budgets.

• Report
• More detail

Does provider competition improve health care quality and efficiency?: expectations and evidence from Europe

European Observatory on Health Systems and Policies -
Provider competition is a feature of several European health systems but policy-makers are split on whether it improves health care quality and efficiency. This briefing finds that the evidence on provider competition in Europe is growing, but it remains limited and clustered in a few countries. It suggests that the proximity to provider remains the main driver of patient choice of hospital. It also looks at other areas of study such as activity-based payments, hospital mergers and the involvement of private providers in the provision of publicly funded hospital care.

• Policy brief
• European Observatory on Health Systems and Policies - publications

Integrating health and social care: state or market?

Institute of Economic Affairs -
This report argues that the only way to facilitate better outcomes in terms of patient care and efficiency, is within a system that allows more competition in healthcare provision with different organisations integrating health and social care according to the preferences of their customers and clients.

• Report
• Institute of Economic Affairs - press release

March 2019 Health Select Committee response: submission by the Competition and Markets Authority

Competition and Markets Authority -
The Health and Social Care Committee has an inquiry open into the legislative proposals put forward to support the implementation of the NHS Long Term Plan. The Committee asked the Competition and Markets Authority to submit information regarding its role in health mergers, and the NHS Tariff.

• Report
• Competition and Markets Authority - publications

Does hospital competition reduce rates of patient harm in the English NHS?

Competition and Markets Authority - 

Previous hospital mergers have reduced the number of distinct organisations offering publicly funded and provided care in the English National Health Service, reducing choice and between-hospital competition in some areas. This working paper tests the impact of variation in concentration on a new quality indicator: the prevalence of patient harm from falls, pressure ulcers, blood clots and urinary tract infections. It exploits a new source of identifying variation accounting for the multi-product nature of hospitals, using instrumental variables to address endogeneity. It finds that hospital mergers in concentrated areas without offsetting clinical benefits could significantly increase rates of patient harm.

• Working paper
• More detail

R&D, competition and diffusion of innovation in the EU: the case of hepatitis C

Office of Health Economics - 

This paper analyses the functioning of a specific market for innovative treatments, Direct Acting Antivirals (DAAs) for hepatitis C virus (HCV), in six European countries. The authors explore potential for in-class competition for DAAs to offset innovators’ market power and to maximise the social welfare generated by the adoption of pharmaceutical innovation via lower prices.

• Paper
• Press release

 

Review of Private Patient Unit arrangements

Competition and Markets Authority (CMA) - 
Private patient units are arrangements by which private hospital operators can manage, operate or private privately-funded care in the UK. This draft guidance sets out principles for the management of mergers and competition in this market. The consultation closes on 22 June 2018.

• Consultation

Divided by choice? Private providers, patient choice and hospital sorting in the English National Health service

Institute for Fiscal Studies (IFS) - 
This study examines the impact of the NHS reforms of the 2000s which enabled privately-owned hospitals to enter the NHS market. It finds that post-reform, poor and ethnic minority patients were much less likely to choose private hospitals; and that the key factors in choice related to the geographic distribution of hospitals and health-based criteria for treatment from private providers.

• Report
• IFS publications

The hospital as a multi-product firm: the effect of hospital competition on value-added indicators of clinical quality

Centre for Economic Performance (CEP) - 
This paper examines the impact of the introduction of patient choice in elective surgical procedures on patient reported outcome measures (PROMs). It finds that by introducing competition via the mechanism of patient choice, there may have been a negative effect of clinical quality.

• Paper
• CEP publications