Research

The COVID-19 pandemic had a profound impact on the management and delivery of acute healthcare. To tackle the pandemic, hospitals redesigned their organisational models to provide a rapid increase in acute care assessment and treatment capacity for patients with COVID-19 whilst also trying to maintain delivery of care for patients with non-COVID-19 healthcare needs. This capacity to adjust and recover after COVID-19 might be shaped by both measures taken by acute hospitals and wider hospital pre-pandemic characteristics. The aim of this study is to examine how hospital characteristics in acute care are associated with recovery of elective activity after the height of the COVID-19 pandemic compared to pre-pandemic levels. Using patient-level data from Hospital Episode Statistics aggregated at monthly-trust level for all English National Health Service (NHS) acute hospital trusts in 2019 and 2021, we estimate the associations between hospital recovery rate and hospital pre-pandemic characteristics by employing linear regressions of the proportional change over time in elective activity against a set of explanatory variables related to supply factors (e.g., hospital size, workforce, type of hospital, regional location), demand factors (e.g., population need, patient case-mix) and time factors. On average, English NHS acute hospital trusts did not fully recover from the COVID-19 pandemic in 2021. The results show that the explanatory variables are not systematically associated with hospital recovery rate, excepting regional differences. Hospital trusts not located in London, especially in the North of England, are associated with a lower recovery (less resilience) of total elective activity and orthopaedic and vascular surgical elective activity. The implication for policy development is that the evolution of hospital recovery rates in elective activity varied across English regions, especially for high-volume and high-risk elective specialties, with better recovery in London than elsewhere.

Waiting times act as a non-price rationing mechanism to bring together the demand for and the supply of public healthcare services and ensure equal access independently of ability to pay. This study tests for the presence of socioeconomic inequalities in waiting times for ten publicly-funded planned and cancer surgeries in Catalonia (Spain) in 2015–2019. Socioeconomic status (SES), measured by four categories (very low, low, middle, high), is based on co-payment levels for medicines which depend on patient's income. Using administrative data, we estimate the association between SES and waiting times controlling for patient characteristics and hospital fixed effects. Compared to patients with low SES, patients with middle SES wait 2–6 fewer days for hip replacement, cataract surgery, and hysterectomy, and less than a day for breast cancer surgery. These inequalities arise within hospitals and are not explained by patient nor hospital characteristics. For some surgeries, the results also show that patients with higher SES are more likely to voluntarily exit the waiting list and have a lower probability of having a surgery canceled for medical reasons and dying while waiting.

We study whether hospitals that exhibit systematically higher bed occupancy rates are associated with lower quality in England over 2010/11–2017/18. We develop an economic conceptual framework to guide our empirical analysis and run regressions to inform possible policy interventions. First, we run a pooled OLS regression to test if high bed occupancy is associated with, and therefore acts as a signal of, lower quality, which could trigger additional regulation. Second, we test whether this association is explained by exogenous demand–supply factors such as potential demand, and unavoidable costs. Third, we include determinants of bed occupancy (beds, length of stay, and volume) that might be associated with quality directly, rather than indirectly through bed occupancy. Last, we use a within-between random-effects specification to decompose these associations into those due to variations in characteristics between hospitals and variations within hospitals. We find that bed occupancy rates are positively associated with overall and surgical mortality, negatively associated with patient-reported health gains, but not associated with other indicators. These results are robust to controlling for demand–supply shifters, beds, and volume. The associations reduce by 12%-25% after controlling for length of stay in most cases and are explained by variations in bed occupancy between hospitals.

Family dynamics and institutions play significant roles in shaping individuals’ health. We evaluate the short- and long-term effects of (1) motherhood and (2) public early childcare on maternal health in Germany. Our results align with an intra-household disease spread after childbirth, which is further amplified by childcare availability. While we find a persistent increase in obesity after childbirth, our findings reveal long-term reductions in hypertension, back pain, nutritional deficiencies, and mental health disorders. These results are supported by childcare availability reducing non-communicable diseases, through better labour market outcomes and healthier behaviours, and improving mental health for multiparous and older mothers.

Early childhood education programmes are expected to improve child conditions including educational attainment, labour, and health outcomes. This study evaluates the effect of a Spanish universal preschool programme, which implied a large-scale expansion of full-time high-quality public preschool for three-year-olds in 1991, on long-term health. Using a difference-in-differences approach, I exploit the timing of the policy and the differential initial speed of implementation of public preschool expansion across regions. I compare long-term health of cohorts aged three before to those aged three after the start of the policy residing in regions with varying initial implementation intensity of the programme. The results show that the policy does not affect long-term health outcomes and use of healthcare services, except for two outcomes. A greater initial intensity in public preschool expansion by 10 percentage points decreases the likelihood of being diagnosed with asthma by 2.1 percentage points, but hospitalisation rates increase by 2.7%. The findings indicate that the effect on asthma is larger for men, hospitalisation rates are higher for pregnant women, and disadvantaged children benefit the most in terms of a lower probability of taking medicines and being diagnosed with asthma and mental health disorders.