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Health Economics Review
Published in: Health Economics Review 1/2024

Open Access 01-12-2024 | Chronic Obstructive Lung Disease | Research

Heterogeneous effects of hospital competition on inpatient quality: an analysis of five common diseases in China

Authors: Yinghui Lu, Qingling Jiang, Xueli Zhang, Xiaojun Lin, Jay Pan

Published in: Health Economics Review | Issue 1/2024

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Abstract

Background

Many countries has introduced pro-competition policies in the delivery of healthcare to improve medical quality, including China. With the increasing intensity of competition in China's healthcare market, there are rising concerns among policymakers about the impact of hospital competition on quality. This study investigated heterogeneous effects of hospital competition on inpatient quality.

Methods

We analyzed the inpatient discharge dataset and selected chronic obstructive pulmonary disease (COPD), ischemic stroke, pneumonia, hemorrhagic stroke, and acute myocardial infarction (AMI) as representative diseases. A total of 561,429 patients in Sichuan Province in 2017 and 2019 were included. The outcomes of interest were in-hospital mortality and 30-day unplanned readmissions. The Herfindahl–Hirschman Index was calculated using predicted patient flows to measure hospital competition. To address the spatial correlations of hospitals and the structure of the dataset, the multiple membership multiple classification model was employed for analysis.

Results

Amid intensifying competition in the hospital market, our study discerned no marked statistical variance in the risk of inpatient quality across most diseases examined. Amplified competition exhibited a positive correlation with heightened in-hospital mortality for both COPD and pneumonia patients. Elevated competition escalated the risk of 30-day unplanned readmissions for COPD patients, while inversely affecting the risk for AMI patients.

Conclusions

There is the heterogeneous impact of hospital competition on quality across various diseases in China. Policymakers who intend to leverage hospital competition as a tool to enhance healthcare quality must be cognizant of the possible influences of it.
Appendix
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Metadata
Title
Heterogeneous effects of hospital competition on inpatient quality: an analysis of five common diseases in China
Authors
Yinghui Lu
Qingling Jiang
Xueli Zhang
Xiaojun Lin
Jay Pan
Publication date
01-12-2024
Publisher
Springer Berlin Heidelberg
Published in
Health Economics Review / Issue 1/2024
Electronic ISSN: 2191-1991
DOI
https://doi.org/10.1186/s13561-024-00504-8

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