Does Hospital Competition Harm Inpatient Quality? Empirical Evidence from Shanxi, China

Xiaojun Lin, Miao Cai, Qiang Fu, Kevin He, Tianyu Jiang, Wei Lu, Ziling Ni and Hongbing Tao
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Xiaojun Lin: Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Miao Cai: Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO 63104, USA
Qiang Fu: Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO 63104, USA
Kevin He: Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
Tianyu Jiang: Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Wei Lu: Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Ziling Ni: Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Hongbing Tao: Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China

IJERPH, 2018, vol. 15, issue 10, 1-14

Abstract: This study aimed to determine whether hospital competition is associated with improved in-hospital mortality in Shanxi, China. We included a total of 46,959 hospitalizations for acute myocardial infarction (AMI) and 44,063 hospitalizations for pneumonia from 2015 to 2017. Hospital competition was measured as Herfindahl–Hirschman Index based on the patient predicted flow approach. Two-level random-intercept logistic models were applied to explore the effects of hospital competition on quality for both AMI and pneumonia diagnoses. Hospital competition exerts negative or negligible effects on inpatient quality of care, and the pattern of competition effects on quality varies by specific diseases. While hospital competition is insignificantly correlated with lower AMI in-hospital mortality (odds ratio (OR): 0.94, 95% confidence interval (CI): 0.77–1.11), high hospital competition was, in fact, associated with higher in-hospital mortality for pneumonia patients (OR: 1.99, 95% CI: 1.51–2.64). Our study suggests that simply encouraging hospital competition may not provide effective channels to improve inpatient quality of health care in China’s current health care system.

Keywords: Hospital competition; acute myocardial infarction; inpatient quality of care; in-hospital mortality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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