Propper C, Croxson B and Shearer A, (2002)

‘Waiting Times for Hospital Admissions: the Impact of GP Fundholding’

Journal of Health Economics, 21 (2): 227-252

Investigates whether GP fundholders were able to secure reduced waiting times for hospital treatment for their patients.
Examines whether this effect, insofar as it is present, was due to the financial rewards they could offer to hospitals, and whether the impact of fundholding spilled over into shorter waiting times for all patients.
Under the Internal Market reforms, fundholders were given funds to pay hospitals directly for some treatments, and could choose the hospital to which they referred each patient.
The authors use all hospital admission data relating to the North West Anglia Health Authority for the years 1993/4 to 1996/7.

Where fundholders paid for their patient’s care, they secured reductions in waiting times of about 8%.
Where they could only choose hospitals, but not pay for care, they were rarely able to reduce the time their patients had to wait for treatment.
The net effect of the scheme on the time fundholders’ patients had to wait for hospital treatment was small and not significantly different from zero.
The incentives created by GP fundholding do not appear to have been catalysts for general changes within hospitals.