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Hospital market competition and health technology diffusion: An empirical study of laparoscopic appendectomy in China

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  • Lin, Xiaojun
  • Lu, Liyong
  • Pan, Jay

Abstract

The evidence about the role of hospital market competition on health technology diffusion in developing countries is scarce. In this study, we examined the association between hospital market competition and the diffusion of health technologies in China's healthcare system. Laparoscopic appendectomy, a minimally invasive surgery for patients with acute appendicitis, was selected as a representative of cost-effective health technology. The inpatient discharge dataset linked to the annually hospital administrative data and to the demographic and socioeconomic data were used. A total of 261,922 patients who were diagnosed with acute appendicitis and had received either open appendectomy or laparoscopic appendectomy at 820 hospitals in Sichuan, China between 2017 and 2019 were included in our analyses. Our outcome measure was the use of laparoscopic appendectomy during hospitalization. We accounted for the endogeneity of hospital competition measures using the Herfindahl-Hirschman Index calculated by predicted patient flows. Controlling for the observable patient, hospital and region characteristics, multivariate logistic regression was performed to model the association between hospital competition and the diffusion of laparoscopic appendectomy. The rapid diffusion of laparoscopic appendectomy over the study period and the substantial variation in use across regions and hospitals were observed. The regression results showed that laparoscopic appendectomy diffused faster in the markets where hospitals faced more competition. Our findings suggest that the diffusion of laparoscopic appendectomy is not only driven by medical factors but also nonmedical factors like hospital market competition. Our study provides new evidence on the association between market structure and technology diffusion in China's hospital market and offers the implications of appropriate technologies diffusion in health for policymakers.

Suggested Citation

  • Lin, Xiaojun & Lu, Liyong & Pan, Jay, 2021. "Hospital market competition and health technology diffusion: An empirical study of laparoscopic appendectomy in China," Social Science & Medicine, Elsevier, vol. 286(C).
    • Handle: RePEc:eee:socmed:v:286:y:2021:i:c:s0277953621006481
    DOI: 10.1016/j.socscimed.2021.114316
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    References listed on IDEAS

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    1. 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.
    2. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2011. "Does Hospital Competition Save Lives? Evidence From The English NHS Patient Choice Reforms," Economic Journal, Royal Economic Society, vol. 121(554), pages 228-260, August.
    3. Daniel P. Kessler & Mark B. McClellan, 2000. "Is Hospital Competition Socially Wasteful?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 577-615.
    4. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    5. Jennifer F. Reinganum, 1981. "Market Structure and the Diffusion of New Technology," Bell Journal of Economics, The RAND Corporation, vol. 12(2), pages 618-624, Autumn.
    6. Wang, Xiuli & Yang, Huazhen & Duan, Zhanqi & Pan, Jay, 2018. "Spatial accessibility of primary health care in China: A case study in Sichuan Province," Social Science & Medicine, Elsevier, vol. 209(C), pages 14-24.
    7. Drew Fudenberg & Jean Tirole, 1985. "Preemption and Rent Equalization in the Adoption of New Technology," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 52(3), pages 383-401.
    8. Poulsen, Peter Bo & Adamsen, Sven & Vondeling, Hindrik & Jorgensen, Torben, 1998. "Diffusion of laparoscopic technologies in Denmark," Health Policy, Elsevier, vol. 45(2), pages 149-167, August.
    9. Varabyova, Yauheniya & Blankart, Carl Rudolf & Greer, Ann Lennarson & Schreyögg, Jonas, 2017. "The determinants of medical technology adoption in different decisional systems: A systematic literature review," Health Policy, Elsevier, vol. 121(3), pages 230-242.
    10. Jill R. Horwitz & Charleen Hsuan & Austin Nichols, 2018. "The Role of Hospital and Market Characteristics in Invasive Cardiac Service Diffusion," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 53(1), pages 81-115, August.
    11. Amitabh Chandra & Jonathan Skinner, 2012. "Technology Growth and Expenditure Growth in Health Care," Journal of Economic Literature, American Economic Association, vol. 50(3), pages 645-680, September.
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