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Heterogeneous effects of hospital competition on inpatient quality: an analysis of five common diseases in China

Author

Listed:
  • Yinghui Lu

    (Sichuan University
    Sichuan University)

  • Qingling Jiang

    (Sichuan University
    Sichuan University)

  • Xueli Zhang

    (Health Information Center of Sichuan Province)

  • Xiaojun Lin

    (Sichuan University
    Sichuan University)

  • Jay Pan

    (Sichuan University
    Sichuan University)

Abstract

Background Many countries has introduced pro-competition policies in the delivery of healthcare to improve medical quality, including China. With the increasing intensity of competition in China's healthcare market, there are rising concerns among policymakers about the impact of hospital competition on quality. This study investigated heterogeneous effects of hospital competition on inpatient quality. Methods We analyzed the inpatient discharge dataset and selected chronic obstructive pulmonary disease (COPD), ischemic stroke, pneumonia, hemorrhagic stroke, and acute myocardial infarction (AMI) as representative diseases. A total of 561,429 patients in Sichuan Province in 2017 and 2019 were included. The outcomes of interest were in-hospital mortality and 30-day unplanned readmissions. The Herfindahl–Hirschman Index was calculated using predicted patient flows to measure hospital competition. To address the spatial correlations of hospitals and the structure of the dataset, the multiple membership multiple classification model was employed for analysis. Results Amid intensifying competition in the hospital market, our study discerned no marked statistical variance in the risk of inpatient quality across most diseases examined. Amplified competition exhibited a positive correlation with heightened in-hospital mortality for both COPD and pneumonia patients. Elevated competition escalated the risk of 30-day unplanned readmissions for COPD patients, while inversely affecting the risk for AMI patients. Conclusions There is the heterogeneous impact of hospital competition on quality across various diseases in China. Policymakers who intend to leverage hospital competition as a tool to enhance healthcare quality must be cognizant of the possible influences of it.

Suggested Citation

  • Yinghui Lu & Qingling Jiang & Xueli Zhang & Xiaojun Lin & Jay Pan, 2024. "Heterogeneous effects of hospital competition on inpatient quality: an analysis of five common diseases in China," Health Economics Review, Springer, vol. 14(1), pages 1-13, December.
    • Handle: RePEc:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-024-00504-8
    DOI: 10.1186/s13561-024-00504-8
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    References listed on IDEAS

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    1. José J. Escarce & Arvind K. Jain & Jeannette Rogowski, 2006. "Hospital Competition, Managed Care and Mortality After Hospitalization for Medical Conditions: Evidence From Three States," NBER Working Papers 12335, National Bureau of Economic Research, Inc.
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