Choice of Contracts in the British National Health Service: An Empirical Study

Following major reforms of the British National Health Service (NHS) in 1990, the roles of purchasing and providing health services were separated, with the relationship between purchasers and providers governed by contracts. Using a mixed multinomial logit analysis, we show how this policy shift led to a selection of contracts that is consistent with the predictions of a simple model, based on contract theory, in which the characteristics of the health services being purchased and of the contracting parties influence the choice of contract form. The paper thus provides evidence in support of the practical relevance of theory in understanding health care market reform.

The Effect of Activity-Based Payment on Dentists’ Activity: Evidence from a Natural Experiment in the UK National Health Service

The extent to which remuneration systems affect the behaviour of health care professionals is of considerable importance in the administration of publicly funded heath care systems. Using data across two jurisdictions in the United Kingdom, in only one of which remuneration was changed, we compare the extent of measured dental activity at the dentist level in order to ascertain the impact of moving to activity-based remuneration. We find that there are large and statistically significant increases in activity as dentists moved to the activity-based system and that a dentist’s previous form of contract is an important determinant of the magnitude of the effect. We also explore the extent to which dentists’ professional attitudes can explain differences in their activity and find that some aspects of self-reported attitudes are associated with observable differences in activity.

Adaptation and anticipation effects to life events in the United Kingdom

We analyze how individual happiness is affected over time by nine major life events using a panel of British individuals. Our aim is to test for the existence of adaptation and anticipation effects. Adaptation effects are found for all the life events considered with the possible exception of unemployment. Anticipation effects precede events that are easily predicted such as marriage, separation and the birth of a child.

Adaptation or Social Comparison? The effects of income on happiness.

Two mechanisms have attracted considerable attention from researchers studying the effects of income on happiness: adaptation and social comparison. In this paper we study both mechanisms using a panel of British households. Besides dealing with the UK case in detail, the paper contributes to the literature by considering the two mecha- nisms together and testing for them both separately and jointly. Our results strongly support the existence of adaptation effects but find only weak evidence in favour of social comparison.

Eye Care Service in Scotland: Did the Scots Get it Right?

In March 2004, the Scottish government announced a review of eye care services in Scotland, which culminated in the introduction of free eye examinations from 1st April 2006. This free eye examination is not just a sight test; it is a thorough examination to check the health of the patient’s eyes and to look for signs of other health problems. The Scottish government commissioned private ophthalmic optician practices to perform these eye examinations. Consequently, since April 2006 individuals in Scotland could walk into any high street optometry practice and get a ‘free’ eye examination funded under the NHS.

Union Mediation and Adaptation to Reciprocal Loyalty Arrangements

This study assesses the industrial relations application of the „loyalty-exit-voice‟ proposition. The loyalty concept is linked to reciprocal employer-employee arrangements and examined as a job attribute in a vignette questionnaire distributed to low and medium-skilled employees. The responses provided by employees in three European countries indicate that reciprocal loyalty arrangements, which involve the exchange of higher effort for job security, are one of the most desirable job attributes. This attribute exerts a higher impact on the job evaluations provided by unionised workers, compared to their non-union counterparts. This pattern is robust to a number of methodological considerations. It appears to be an outcome of adaptation to union mediated cooperation. Overall the evidence suggests that the loyalty-job evaluation profiles of unionised workers are receptive to repeated interaction and negative shocks, such as unemployment experience. This is not the case for the non-union workers. Finally, unionised workers appear to „voice‟ a lower job satisfaction, but exhibit low „exit‟ intentions, compared to the non-unionised labour.