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Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

Author

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  • R. R. Croes

    () (NZa (Dutch Healthcare Authority) and Erasmus University Rotterdam)

  • Y. J. F. M. Krabbe-Alkemade

    () (NZa (Dutch Healthcare Authority) and Free University Amsterdam)

  • M. C. Mikkers

    () (NZa (Dutch Healthcare Authority) and Tilburg University)

Abstract

There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008–2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.

Suggested Citation

  • R. R. Croes & Y. J. F. M. Krabbe-Alkemade & M. C. Mikkers, 2018. "Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 19(1), pages 5-19, January.
  • Handle: RePEc:spr:eujhec:v:19:y:2018:i:1:d:10.1007_s10198-016-0862-6
    DOI: 10.1007/s10198-016-0862-6
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    References listed on IDEAS

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    Cited by:

    1. 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," Other publications TiSEM 5302ab6a-9099-4b5d-9874-8, Tilburg University, School of Economics and Management.
    2. 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.
    3. 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," Other publications TiSEM e30db5a4-5c1c-450b-8f1d-6, Tilburg University, School of Economics and Management.

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    More about this item

    Keywords

    Competition; Quality; Hospitals; Market structure;
    All these keywords.

    JEL classification:

    • I - Health, Education, and Welfare
    • L - Industrial Organization
    • L - Industrial Organization

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