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Hospital competition, service provision and quality: Evidence from maternity units

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  • Karamik, Yasemin
  • Reif, Simon

Abstract

Maternity unit closures are increasingly common in areas with low birth rates, resulting in diminished competition between units. We examine how competition affects the quality and amenities of the remaining maternity units in Germany. To address potential endogeneity in the level of competition, we exploit the unpopularity of maternity unit closures and instrument competition with the tightness of past regional elections. Our findings indicate that while low competition does not significantly affect the quality of care, it leads to reduced availability of additional services potentially used to attract patients in the higher competitive market.

Suggested Citation

  • Karamik, Yasemin & Reif, Simon, 2025. "Hospital competition, service provision and quality: Evidence from maternity units," ZEW Discussion Papers 25-025, ZEW - Leibniz Centre for European Economic Research.
    • Handle: RePEc:zbw:zewdip:319895
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    References listed on IDEAS

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    1. Alfons Palangkaraya & Jongsay Yong, 2013. "Effects of competition on hospital quality: an examination using hospital administrative data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 415-429, June.
    2. 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.
    3. Mennicken, Roman & Kolodziej, Ingo W.K. & Augurzky, Boris & Kreienberg, Rolf, 2014. "Concentration of gynaecology and obstetrics in Germany: Is comprehensive access at stake?," Health Policy, Elsevier, vol. 118(3), pages 396-406.
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    Keywords

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    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L13 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Oligopoly and Other Imperfect Markets

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