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

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

Abstract

We analyze the causal impact of competition on managerial quality (and hospital performance). To address the endogeneity of market structure we analyze the English public hospital sector where entry and exit are controlled by the central government. Because closing hospitals in areas where the governing party is expecting a tight election race ("marginals") is rare due to the fear of electoral defeat, we can use political marginality as an instrumental variable for the number of hospitals in a geographical area. We find that higher competition is positively correlated with management quality, measured using a new survey tool. Adding a rival hospital increases management quality by 0.4 standard deviations and increases survival rates from emergency heart attacks by 8.8%. We confirm the validity of our IV strategy by conditioning on marginality in the hospital's own catchment area, thus identifying purely off the marginality of rival hospitals. This controls for "hidden policies" that could be used in marginal districts to improve hospital management. We also run placebo tests of marginality on schools, a public service where the central government has no formal influence on market structure.

Suggested Citation

  • Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2010. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," CEP Discussion Papers dp0983, Centre for Economic Performance, LSE.
  • Handle: RePEc:cep:cepdps:dp0983
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    More about this item

    Keywords

    management; hospitals; competition; productivity;
    All these keywords.

    JEL classification:

    • J45 - Labor and Demographic Economics - - Particular Labor Markets - - - Public Sector Labor Markets
    • F12 - International Economics - - Trade - - - Models of Trade with Imperfect Competition and Scale Economies; Fragmentation
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J31 - Labor and Demographic Economics - - Wages, Compensation, and Labor Costs - - - Wage Level and Structure; Wage Differentials

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