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

Zixuan Peng (), Audrey Laporte (), Xiaolin Wei (), Xinping Sha () and Peter C. Coyte ()
Additional contact information
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

Health Economics Review, 2024, vol. 14, issue 1, 1-13

Abstract: 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.

Keywords: Hospital competition; Quality of care; China (search for similar items in EconPapers)
Date: 2024
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
http://link.springer.com/10.1186/s13561-024-00516-4 Abstract (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-024-00516-4

Ordering information: This journal article can be ordered from
http://www.springer.com/journal/13561

DOI: 10.1186/s13561-024-00516-4

Access Statistics for this article

Health Economics Review is currently edited by J. Matthias Graf von der Schulenburg

More articles in Health Economics Review from Springer
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().