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Consumer choice, competition and privatisation in European health and long-term care systems: subjective well-being effects and equity implications

Zigante, Valentina (2013) Consumer choice, competition and privatisation in European health and long-term care systems: subjective well-being effects and equity implications. PhD thesis, London School of Economics and Political Science.

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Consumer choice has become a key reform trend in the provision of public services in Western European welfare states. Research on the welfare effects of choice reforms – including greater provider choice for the individual and competition between providers – has largely focused on economic evaluations of the extrinsic (outcome) effects of choice, thereby leaving its intrinsic, or procedural, value unexplored. The overarching objective of this thesis is to investigate the welfare effects of choice in the provision of health and long-term care (LTC) and their implications for equity. The thesis utilises the subjective well-being approach – incorporating both procedural and outcome utility from choice – to measure welfare effects based on quantitative analysis of survey data. Welfare effects and equity implications are examined in relation to: competition in health care in the English National Health System (NHS); choice of care package in the German long-term care system; and individual preferences and views of choice as a priority in the provision of health care in three NHS countries. The thesis argues that both service characteristics – extent of competition, information availability, technical complexity – and individual capabilities – ability to process information, capacity to manage transaction costs, availability of private support – influence the benefits that individuals derive from choice. Results suggest that choice policies have an overall positive welfare effect in both health and long-term care. However, while direct evidence of outcome improvements is found, the empirical analysis only finds indirect evidence of procedural utility. Middle class characteristics, primarily income and education, are found to have a positive influence on the benefits of choice, amounting to evidence of inequitable facets of choice policies. The middle class further exhibits preferences for choice over and above other characteristics of health care systems. Overall, this thesis advocates a holistic approach to the analysis of choice, incorporating its procedural value and paying particular attention to the equity implications of the choice situation, information processing and differences in available options as well as preferences for choice.

Item Type: Thesis (PhD)
Additional Information: © 2013 Valentina Zigante
Library of Congress subject classification: H Social Sciences > HC Economic History and Conditions
H Social Sciences > HJ Public Finance
J Political Science > JN Political institutions (Europe)
R Medicine > RA Public aspects of medicine
Sets: Departments > European Institute
Supervisor: Monastiriotis, Vassilis and Costa-Font, Joan

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