Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms


  •  Corresponding author: Zack Cooper, The Centre for Economic Performance, London School of Economics, Houghton Street, London WC2A 2AE. Email:

  • We would like to thank Hugh Gravelle, Mireia Jofre-Bonet, Julian Le Grand, John Van Reenen, Joan Costa-Font, three anonymous referees and the editorial staff at this JOURNAL for their feedback on earlier drafts of this article. We would also like to thank participants at the various forums where earlier drafts of this article were presented for their valuable contributions. This research was funded by an LSE PhD Studentship and an ESRC Postdoctoral Fellowship. All errors are our own.

  • Correction Note: This article was first published online on the 21st of July 2011, under a subscription publication licence. The article has since been made OnlineOpen, and the copyright line and licence statement was therefore updated in June 2014.


Recent substantive reforms to the English National Health Service expanded patient choice and encouraged hospitals to compete within a market with fixed prices. This study investigates whether these reforms led to improvements in hospital quality. We use a difference-in-difference-style estimator to test whether hospital quality (measured using mortality from acute myocardial infarction) improved more quickly in more competitive markets after these reforms came into force in 2006. We find that after the reforms were implemented, mortality fell (i.e. quality improved) for patients living in more competitive markets. Our results suggest that hospital competition can lead to improvements in hospital quality.