The effect of hospital spending on waiting times

Callum Brindley*, James Lomas, Luigi Siciliani

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
18 Downloads (Pure)


Long waiting times have been a persistent policy issue in the United Kingdom that the COVID-19 pandemic has exacerbated. This study analyses the causal effect of hospital spending on waiting times in England using a first-differences panel approach and an instrumental variable strategy to deal with residual concerns for endogeneity. We use data from 2014 to 2019 on waiting times from general practitioner referral to treatment (RTT) measured at the level of local purchasers (known as Clinical Commissioning Groups). We find that increases in hospital spending by local purchasers of 1% reduce median RTT waiting time for patients whose pathway ends with a hospital admission (admitted pathway) by 0.6 days but the effect is not statistically significant at 5% level (only at the 10% level). We also find that higher hospital spending does not affect the RTT waiting time for patients whose pathway ends with a specialist consultation (non-admitted pathway). Nor does higher spending have a statistically significant effect on the volume of elective activity for either pathway. Our findings suggest that higher spending is no guarantee of higher volumes and lower waiting times, and that additional mechanisms need to be put in place to ensure that increased spending benefits elective patients.

Original languageEnglish
Pages (from-to)2427-2445
Number of pages19
JournalHealth Economics (United Kingdom)
Issue number11
Early online date9 Jul 2023
Publication statusPublished - Nov 2023

Bibliographical note

JEL Classification: C26, I11, I18

Publisher Copyright:
© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.


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