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Does hospital competition improve health care delivery in China?

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  • Pan, Jay
  • Qin, Xuezheng
  • Li, Qian
  • Messina, Joseph P.
  • Delamater, Paul L.

Abstract

This paper analyzes whether hospital competition is associated with improved health care delivery in China, particularly in the dimensions of health care quality and cost. We explore the differences in competition over time and across regions to examine the relationship in an environment wherein the hospital industry is largely state owned, the price of medical care is partially regulated, and hospitals can compete on both quality and cost. Using provincial- and individual-level data, along with a set of outcome indicators, we find that hospital competition is significantly correlated with lower observation room mortality, shorter outpatient waiting time, and fewer outpatient costs, while we do not find evidence that would suggest negative influences of competition on the other measures of hospital performance. Our results offer new evidence in support of competition-based reforms in China's health care sector and provide implications for other developing countries facing similar health care challenges.

Suggested Citation

  • Pan, Jay & Qin, Xuezheng & Li, Qian & Messina, Joseph P. & Delamater, Paul L., 2015. "Does hospital competition improve health care delivery in China?," China Economic Review, Elsevier, vol. 33(C), pages 179-199.
    • Handle: RePEc:eee:chieco:v:33:y:2015:i:c:p:179-199
    DOI: 10.1016/j.chieco.2015.02.002
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    2. Pan, Jay & Liu, Dan & Ali, Shehzad, 2015. "Patient dissatisfaction in China: What matters," Social Science & Medicine, Elsevier, vol. 143(C), pages 145-153.
    3. Yun Liu & Qingxia Kong & Shasha Yuan & Joris van de Klundert, 2018. "Factors influencing choice of health system access level in China: A systematic review," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-21, August.
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    5. Rój Justyna, 2016. "Competition Measurement of Hospitals in Poland: The Herfindahl-Hirschman Index Approach," Ekonomika (Economics), Sciendo, vol. 95(1), pages 166-181, January.
    6. Xuan Sun & Weikai Wang & Tao Sun & Ya Ping Wang, 2018. "Understanding the Living Conditions of Chinese Urban Neighborhoods through Social Infrastructure Configurations: The Case Study of Tianjin," Sustainability, MDPI, vol. 10(9), pages 1-17, September.
    7. Carrie Colla & Julie Bynum & Andrea Austin & Jonathan Skinner, 2016. "Hospital Competition, Quality, and Expenditures in the U.S. Medicare Population," NBER Working Papers 22826, National Bureau of Economic Research, Inc.
    8. Lu, Liyong & Pan, Jay, 2019. "The association of hospital competition with inpatient costs of stroke: Evidence from China," Social Science & Medicine, Elsevier, vol. 230(C), pages 234-245.
    9. Wang, Qing & Zhang, Donglan & Hou, Zhiyuan, 2016. "Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China," Social Science & Medicine, Elsevier, vol. 170(C), pages 124-132.
    10. Xiaojun Lin & Miao Cai & Qiang Fu & Kevin He & Tianyu Jiang & Wei Lu & Ziling Ni & Hongbing Tao, 2018. "Does Hospital Competition Harm Inpatient Quality? Empirical Evidence from Shanxi, China," IJERPH, MDPI, vol. 15(10), pages 1-14, October.
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    12. Guanfu Fang & Hui Cao, 2020. "State versus private provision: How does China’s market‐oriented reform affect healthcare delivery?," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 28(3), pages 381-411, July.

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    More about this item

    Keywords

    Hospital competition; Health care quality; Health care cost; China;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L10 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - General
    • L30 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - General

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