Are geographic variations in secondary hospital expenditure caused by supply and demand factors? Evidence from migration in England

Datos Bibliográficos

ID8018123
AutoresSean Urwin (0000-0002-9084-8368, Manchester Academic Health Science Centre), Laura Anselmi (0000-0002-2499-7656, University of Manchester), Yiu-Shing Lau (0000-0002-3915-4168, University of Manchester), Madeline Sutton (0000-0002-6635-2127, University of Manchester)
Año2025
Volumen383
Páginas118439-118439
Fecha de publicación2025-07-19
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaSocial Science & Medicine (JOURNAL)
Identificadores de la revistaISSN: 0277-9536 • E-ISSN: 1873-5347
EditorialElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2025.118439
PMID40712437
OpenAlexW4412707553
IdiomaEN
Citas recibidas1
Referencias citadas25

Regional variations in hospital expenditure are a global concern because they may reflect unmet healthcare needs or inefficient resource use. Several recent studies have used internal migration to differentiate demand and supply causes of these regional variations. Most of these studies have focused on specific populations in competitive insurance settings and have not fully considered the timing of individual migrations. Using individual level data on 55 million patients from national Hospital Episode Statistics between 2010 and 2018, we examine geographical variations in overall hospital expenditure and in admissions (emergency and planned), outpatient visits and emergency department attendances. We estimate models similar to the need-based formula used by the English NHS to allocate resources to local commissioners, but we include individual fixed effects to capture demand factors. We find that 10-18 % of the regional variation in hospital expenditure stems from supply-side factors. This contribution is higher for ambulatory care (67.70 % for emergency department attendances and 56.89 % for specialist visits) than for hospital admissions, emergency (12.99 %) and planned (17.91 %). We also find that, after adjusting for need indicators, hospital expenditure is on average higher when individuals live in northern England and in regions with lower prices and higher than expected budget allocations. Despite this significant variation, the share attributable to supply in the English NHS is lower than other countries. Our results have implications for debates about regional variations in health care expenditure and for the importance and design of needs-based resource allocation

Demographic economics · Economic growth · Economics · Environmental health · Geography · New england · Physician supply · Population · Sociology · Demography · Employment and Welfare Studies · Global Health Care Issues · Global Health Workforce Issues · Medicine