IDEAS home Printed from https://ideas.repec.org/a/vrs/ekonom/v95y2016i1p166-181n9.html
   My bibliography  Save this article

Competition Measurement of Hospitals in Poland: The Herfindahl-Hirschman Index Approach

Author

Listed:
  • Rój Justyna

    (The Poznań University of Economics, Department of Operational Research, Al. Niepodległości 10, 61-875Poznań, Poland)

Abstract

The purpose of this study was to measure the competition level of general hospitals in Poland. The Herfindahl-Hirschman Index (HHI) was used to investigate the concentration level of the general hospital sector in Poland, which is treated in the literature as a proxy of competition. To understand how general hospitals’ market has been structured and thus competitive, the data for general hospitals spanning all Poland for the period of 2005-2013 were collected. The concentration of hospitals was measured in each of the 16 provinces in Poland based on the aggregated data at the counties level. Data are collected from the public statistical system. The HHI indices support the assertion that in the period of analysis the entire general hospitals’ sector in Poland has been on average moderately concentrated and thus, moderately competitive with the growing tendency to higher concentration and less competition. Moreover, the concentration of hospitals’ services is diversified across the provinces and regions of Poland and it is quite uneven. The analysis also shows that changes in the health care market, which took place in the analysed period, especially statutory changes regarding hospitals in 2011, affected the level of concentration and thus competition. Including this introduction, this paper is organized into six sections. Section 2 outlines the Polish health care reforms especially those applying to hospitals. Section 3 and 4 presents the concept of empirical research, such as data and method. Section 5 provides results of empirical research and section 6 concludes.

Suggested Citation

  • Rój Justyna, 2016. "Competition Measurement of Hospitals in Poland: The Herfindahl-Hirschman Index Approach," Ekonomika (Economics), Sciendo, vol. 95(1), pages 166-181, January.
    • Handle: RePEc:vrs:ekonom:v:95:y:2016:i:1:p:166-181:n:9
    DOI: 10.15388/ekon.2016.1.9912
    as

    Download full text from publisher

    File URL: https://doi.org/10.15388/ekon.2016.1.9912
    Download Restriction: no
    File URL: https://libkey.io/10.15388/ekon.2016.1.9912?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    2. R. Halbersma & M. Mikkers & E. Motchenkova & I. Seinen, 2011. "Market structure and hospital–insurer bargaining in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 589-603, December.
    3. Djolov, George, 2013. "The Herfindahl-Hirschman Index as a decision guide to business concentration: A statistical exploration," Journal of Economic and Social Measurement, IOS Press, issue 3, pages 201-227.
    4. Gaynor, Martin & Vogt, William B., 2000. "Antitrust and competition in health care markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 27, pages 1405-1487, Elsevier.
    5. David M. Cutler, 2002. "Equality, Efficiency, and Market Fundamentals: The Dynamics of International Medical-Care Reform," Journal of Economic Literature, American Economic Association, vol. 40(3), pages 881-906, September.
    6. Chen, Chi-Chen & Cheng, Shou-Hsia, 2010. "Hospital competition and patient-perceived quality of care: Evidence from a single-payer system in Taiwan," Health Policy, Elsevier, vol. 98(1), pages 65-73, November.
    7. 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.
    8. Cutler, David, 2002. "Equality, Efficiency, and Market Fundamentals: The Dynamics of International Medical Care Reform," Scholarly Articles 2640584, Harvard University Department of Economics.
    9. Shiell, Alan, 1991. "Competing hospitals: Assessing the impact of self-governing status in the United Kingdom," Health Policy, Elsevier, vol. 19(2-3), pages 141-158, December.
    10. Zwanziger, Jack & Melnick, Glenn A. & Mann, Joyce M., 1990. "Measures of hospital market structure: a review of the alternatives and a proposed approach," Socio-Economic Planning Sciences, Elsevier, vol. 24(2), pages 81-95.
    11. Schmid, Andreas & Ulrich, Volker, 2013. "Consolidation and concentration in the German hospital market: The two sides of the coin," Health Policy, Elsevier, vol. 109(3), pages 301-310.
    12. George J. Stigler, Chairman, Universities-National Bureau Committee for Economic Research, 1955. "Business Concentration and Price Policy," NBER Books, National Bureau of Economic Research, Inc, number univ55-1.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Schmid, Andreas & Ulrich, Volker, 2013. "Consolidation and concentration in the German hospital market: The two sides of the coin," Health Policy, Elsevier, vol. 109(3), pages 301-310.
    2. Westra, Daan & Angeli, Federica & Carree, Martin & Ruwaard, Dirk, 2017. "Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective," Health Policy, Elsevier, vol. 121(2), pages 149-157.
    3. Mikkers, Misja, 2016. "The Dutch Healthcare System in International Perspective," Other publications TiSEM 800704a0-24ee-4830-8659-2, Tilburg University, School of Economics and Management.
    4. R. Halbersma & M. Mikkers & E. Motchenkova & I. Seinen, 2011. "Market structure and hospital–insurer bargaining in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 589-603, December.
    5. 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.
    6. 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.
    7. Anne‐Fleur Roos & Ramsis R. Croes & Victoria Shestalova & Marco Varkevisser & Frederik T. Schut, 2019. "Price effects of a hospital merger: Heterogeneity across health insurers, hospital products, and hospital locations," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1130-1145, September.
    8. Cooper, Zack & Gibbons, Stephen & Skellern, Matthew, 2018. "Does competition from private surgical centres improve public hospitals' performance? Evidence from the English National Health Service," Journal of Public Economics, Elsevier, vol. 166(C), pages 63-80.
    9. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    10. van Dijk, T.S. (Tessa) & van der Scheer, W.K. (Wilma) & Janssen, R.T.J.M. (Richard), 2021. "Power, legitimacy and urgency: Unravelling the relationship between Dutch healthcare organisations and their financial stakeholders," Health Policy, Elsevier, vol. 125(8), pages 1077-1084.
    11. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    12. Westra, Daan & Angeli, Federica & Jatautaitė, Evelina & Carree, Martin & Ruwaard, Dirk, 2016. "Understanding specialist sharing: A mixed-method exploration in an increasingly price-competitive hospital market," Social Science & Medicine, Elsevier, vol. 162(C), pages 133-142.
    13. Y. J. F. M. Krabbe-Alkemade & T. L. C. M. Groot & M. Lindeboom, 2017. "Competition in the Dutch hospital sector: an analysis of health care volume and cost," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(2), pages 139-153, March.
    14. Westra, Daan & Wilbers, Gloria & Angeli, Federica, 2016. "Stuck in the middle?," Health Policy, Elsevier, vol. 120(4), pages 345-349.
    15. Mads Leth Felsager Jakobsen & Thomas Pallesen, 2017. "Performance Budgeting in Practice: the Case of Danish Hospital Management," Public Organization Review, Springer, vol. 17(2), pages 255-273, June.
    16. Martin Gaynor, "undated". "What Do We Know About Competition and Quality in Health Care Markets?," GSIA Working Papers 2006-E62, Carnegie Mellon University, Tepper School of Business.
    17. Parida Wubulihasimu & Werner Brouwer & Pieter van Baal, 2016. "The Impact of Hospital Payment Schemes on Healthcare and Mortality: Evidence from Hospital Payment Reforms in OECD Countries," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 1005-1019, August.
    18. repec:zbw:rwirep:0527 is not listed on IDEAS
    19. Berden, Carolien & Croes, R. & Kemp, R. & Mikkers, Misja & van der Noll, Rob & Shestalova, V. & Svitak, Jan, 2019. "Hospital Competition in the Netherlands : An Empirical Investigation," Discussion Paper 2019-008, Tilburg University, Tilburg Law and Economic Center.
    20. R. Forrest McCluer & Martha A. Starr, 2013. "Using Difference in Differences to Estimate Damages in Healthcare Antitrust: A Case Study of Marshfield Clinic," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 20(3), pages 447-469, November.
    21. Chiara Brouns & Rudy Douven & Ron Kemp, 2021. "Prices and market power in mental health care: Evidence from a major policy change in the Netherlands," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 803-819, April.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:vrs:ekonom:v:95:y:2016:i:1:p:166-181:n:9. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Peter Golla (email available below). General contact details of provider: https://www.sciendo.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.