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The Impact of Competition on Management Quality: Evidence from Public Hospitals

  • Bloom, Nicholas
  • Propper, Carol
  • Seiler, Stephan
  • Van Reenen, John

In this paper we examine the causal impact of competition on management quality. We analyze the hospital sector where geographic proximity is a key determinant of competition, and English public hospitals where political competition can be used to construct instrumental variables for market structure. Since almost all major English hospitals are government run, closing hospitals in areas where the governing party has a small majority is rare due to fear of electoral punishment. We find that management quality - measured using a new survey tool - is strongly correlated with financial and clinical outcomes such as survival rates from emergency heart attack admissions (AMI). More importantly, we find that higher competition (as indicated by a greater number of neighboring hospitals) is positively correlated with increased management quality, and this relationship strengthens when we instrument the number of local hospitals with local political competition. Adding another rival hospital increases the index of management quality by one third of a standard deviation and leads to a 10.7% reduction in heart-attack mortality rates.

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Paper provided by C.E.P.R. Discussion Papers in its series CEPR Discussion Papers with number 7862.

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Date of creation: Jun 2010
Date of revision:
Handle: RePEc:cpr:ceprdp:7862
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  1. Timothy Besley & Torsten Persson & Daniel Sturm, 2005. "Political Competition and Economic Performance: Theory and Evidence from the United States," NBER Working Papers 11484, National Bureau of Economic Research, Inc.
  2. Lucia Foster & John Haltiwanger & Chad Syverson, 2005. "Reallocation, Firm Turnover, and Efficiency: Selection on Productivity or Profitability?," NBER Working Papers 11555, National Bureau of Economic Research, Inc.
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