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Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city

Author

Listed:
  • Zixuan Peng

    (Southeast University)

  • Audrey Laporte

    (University of Toronto)

  • Xiaolin Wei

    (University of Toronto)

  • Xinping Sha

    (Xiangya School of Medicine, Central South University)

  • Peter C. Coyte

    (University of Toronto)

Abstract

Background Although countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care. Methods The dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care. Results We demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual’s risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts. Conclusion This study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.

Suggested Citation

  • Zixuan Peng & Audrey Laporte & Xiaolin Wei & Xinping Sha & Peter C. Coyte, 2024. "Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city," Health Economics Review, Springer, vol. 14(1), pages 1-13, December.
  • Handle: RePEc:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-024-00516-4
    DOI: 10.1186/s13561-024-00516-4
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    References listed on IDEAS

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    1. 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.
    2. Matthew Skellern, 2017. "The hospital as a multi-product firm: the effect of hospital competition on value-added indicators of clinical quality," CEP Discussion Papers dp1484, Centre for Economic Performance, LSE.
    3. Douven, Rudy & Burger, Monique & Schut, Frederik, 2020. "Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands," Health Economics, Policy and Law, Cambridge University Press, vol. 15(3), pages 341-354, July.
    4. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165, February.
    5. 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.
    6. Francesco Longo & Luigi Siciliani & Giuseppe Moscelli & Hugh Gravelle, 2019. "Does hospital competition improve efficiency? The effect of the patient choice reform in England," Health Economics, John Wiley & Sons, Ltd., vol. 28(5), pages 618-640, May.
    7. Hugh Gravelle & Rita Santos & Luigi Siciliani & Rosalind Goudie, 2012. "Hospital Quality Competition Under Fixed Prices," Working Papers 080cherp, Centre for Health Economics, University of York.
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