Summertime and the drivin’ is easy? Daylight saving time and vehicle accidents

We investigate how exogenous variation in daylight caused by Daylight Saving Time affects road safety as measured by the count of vehicle crashes. We use administrative daily data from Greece covering the universe of all types of recorded vehicle accidents during the 2006–2016 period. Our regression discontinuity estimates support an ambient light mechanism that reduces the counts of serious vehicle accidents during the Spring transition and increases the count of minor ones during the Fall transition. The effects are driven from the hour intervals that are mostly affected from seasonal clock changes. We then discuss the potential cost implications of those seasonal transitions. In light of the talks about abolishing seasonal clock changes in the European Union (EU), our findings are policy relevant and can inform the public debate as empirical evidence for the block is scarce

Trends and determinants of clinical staff retention in the English NHS : A double retrospective cohort study

Acknowledgements We thank the Department of Health and Social Care and NHS England, respectively, for the access to NHS Electronic Staff Record (ESR) and NHS Staff Survey (NSS) data at individual worker levelPeer reviewe

Location, quality and choice of hospital: Evidence from England 2002–2013

We investigate (a) how patient choice of hospital for elective hip replacement is influenced by distance, quality and waiting times, (b) differences in choices between patients in urban and rural locations, (c) the relationship between hospitals' elasticities of demand to quality and the number of local rivals, and how these changed after relaxation of constraints on hospital choice in England in 2006. Using a data set on over 500,000 elective hip replacement patients over the period 2002 to 2013 we find that patients became more likely to travel to a provider with higher quality or lower waiting times, the proportion of patients bypassing their nearest provider increased from 25% to almost 50%, and hospital elasticity of demand with respect to own quality increased. By 2013 average hospital demand elasticity with respect to readmission rates and waiting times were −0.2 and −0.04. Providers facing more rivals had demand that was more elastic with respect to quality and waiting times. Patients from rural areas have smaller disutility from distance

Heterogeneous effects of patient choice and hospital competition on mortality

We examine whether the relaxation of constraints on patient choice of hospital in the English National Health Service in 2006 led to greater changes in mortality for hospitals which faced more rivals before the choice reform. We use patient level data from 2002 to 2010 for three high volume emergency conditions with high mortality risk: acute myocardial infarction (AMI) (288,279 patients), hip fracture (91,005 patients), stroke (214,103 patients). Since mortality risk varies by sub-diagnoses of AMI and stroke we include indicators for sub-diagnoses in the covariates. We also allow for the effect of covariates on mortality to differ before and after the 2006 choice reform. We find that the choice reform reduced mortality risk for hip fracture patients by 0.62% (95% CI: 1.22%, 0.01%), compared with the 2002/3–2010/11 mean of 3.5%, but had statistically insignificant negative effects for AMI and stroke. The reform also had heterogeneous effects across AMI and stroke sub-diagnoses, reducing mortality for 3% of AMI patients and 21% of stroke patients. The reduction in hip fracture mortality was greater for more deprived patients. Policies to increase competition and give patients greater choice are likely to have heterogeneous effects depending on details of patient case mix and market conditions

Socioeconomic inequality of access to healthcare: : Does patients’ choice explain the gradient?Evidence from the English NHS

Equity of access is a key policy objective in publicly-funded healthcare systems. Using data on patients undergoing non-emergency heart revascularization procedures in the English National Health Service, we find evidence of significant differences in waiting times within public hospitals between patients with different socioeconomic status (up to 35% difference between the most and least deprived population quintiles). We employ selection models to test whether such differences are explained by patients exercising choice over hospital or type of treatment. Selection bias due to choice has a limited effect on the gradient suggesting the presence of substantial inequities within the public system

Patient choice and the effects of hospital market structure on mortality for AMI, hip fracture and stroke patients

We examine (a) the effect of market structure on the level of mortality for AMI, hip fracture, and stroke between 2002/3 and 2010/11 and (b) whether this effect changed after the introduction of Choice policy in 2006 which gave patients the right to a wider choice of hospital. For AMI and hip fracture, hospitals with more rivals had higher mortality at the beginning of the period but this effect became smaller over the period. We find that the decline in the detrimental effect of market structure predated the introduction of Choice. Market structure had no effect on stroke mortality

Market structure, patient choice and hospital quality for elective patients

We examine the change in the effect of market structure on hospital quality for elective procedures (hip and knee replacements, and coronary artery bypass grafts) following the 2006 loosening of restrictions on patient choice of hospital in England. We allow for time-varying endogeneity due to the effect of  unobserved patient characteristics on patient choice of hospital using Two Stage Residual Inclusion. We find that the change in the effect of market structure due to the 2006 choice reforms was to reduce quality by increasing the probability of a post-operative emergency readmission for hip and knee replacement patients. There was no effect of the choice reform on hospital quality for coronary bypass patients. We find no evidence of self-selection of patients into hospitals, suggesting that a rich set of patient-level covariates controls for differences in casemix

Effects of market structure and patient choice on hospital quality for planned patients

We investigate the change in the effect of market structure on planned hospital quality for three high-volume treatments, using a quasi difference in differences approach based on the relaxation of patient constraints on hospital choice in England. We employ control functions to allow for time-varying endogeneity from unobserved patient characteristics. We find that the choice reforms reduced quality for hip and knee replacement but not for coronary bypass. This is likely due to hospitals making a larger loss on hip and knee replacements, since robustness checks rule out changes in length of stay, new competitors’ entry and hospital-level mortality as possible confounders

The effect of hospital ownership on quality of care : evidence from England.

We investigate whether quality of care differs between public and private hospitals in England with data on 3.8 million publicly-funded patients receiving 133 planned (non-emergency) treatments in 393 public and 190 private hospitalsites. Private hospitals treat patients with fewer comorbidities and past hospitalisations. Controlling for observed patient characteristics and treatment type, private hospitals have fewer emergency readmissions. Conversely, after instrumenting the choice of hospital type by the difference in distances from the patient to the nearest public and the nearest private hospital, the effect of ownership is smaller and statistically insignificant. Similar results are obtained with coarsened exact matching. We also find no quality differences between hospitals specialising in planned treatments and other hospitals, nor between for-profit and not-for-profit private hospitals. Our results show the importance of controlling for unobserved patient heterogeneity when comparing quality of public and private hospitals

Do patients choose hospitals that improve their health?

Many health care systems collect and disseminate information on provider quality in order to facilitate patient choice and induce competitive behaviour amongst providers. The Department of Health in England has recently mandated the collection of patient-reported health outcome measures (PROMs) for the purpose of performance assessment and consumer information. This is the first attempt to routinely measure the gain in health that patients experience as the result of care and thus offer a more comprehensive picture of hospital quality than existing ‘failure measures’ such as mortality or readmission rates. In this paper we test whether hospital demand responds to hospital quality measures based on health gains in addition to more conventional measures. We estimate hospital choice models for elective hip replacement surgery using rich administrative data for all publicly-funded patients in the English NHS in 2010-2012. Our focus is on two key aspects of hospital choice: 1) the extent to which patients are more likely to choose hospitals which are expected to achieve larger improvements in patients’ health and 2) whether patients’ response to quality differs with their morbidity, as measured by pre-operative health status, and other characteristics such as age or income deprivation. In order to address potential endogeneity bias we implement an empirical strategy based on lagged explanatory variables, hospital fixed effects and a control group design based on demand for emergency hip replacement. Our results suggest that hospitals can increase demand by 9% if they increase the average health gains that patients experience by one standard deviation. Hospital demand has a higher elasticity with respect to average health gains than emergency readmission or mortality rates. Elective patients are twice as willing as emergency hip replacement patients to travel further for an increase in quality