Moving the quality needle? Provider choice, waiting times and clinical outcomes

Abstract

We study the effect of expanding patient choice of healthcare provider on care process and clinical outcomes central to the functioning of a health system, using a quasi‐natural experiment in Spain over 2002–2019. Exploiting the staggered adoption of provider choice reforms across Spanish regional health services, we estimate heterogeneity‐robust difference‐in‐differences models on region–year panel data alongside individual‐level survey data. We find that the availability of provider choice reduces specialist waiting times by approximately 17 days (19% of the pre‐reform mean) and the use of private specialist visits, without increasing public health spending. The waiting time and private utilization results are robust to excluding the region where the 2009 reform bundled choice with new hospitals, public–private partnerships, and a budget increase. Although we cannot reject zero effects on some clinical outcomes, the evidence is consistent with the thesis that provider choice improves the ‘quality needle’, namely, it improves observable process quality without affecting less‐visible clinical dimensions.