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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Control under times of uncertainty: the relationship between hospital competition and physician-patient disputes

Authors: Qian Yang, Jay Pan

Published in: International Journal for Equity in Health | Issue 1/2017

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Abstract

Background

Recently, cases of medical disputes and even acts of violence toward physicians by patients in China have been escalating. It remains unknown whether competition improves the patient-physician relationship.

Methods

This paper analyzes the relationship between hospital competition and the probability of medical disputes occurrence according to the theory of social control. Data from all hospitals in the Sichuan province of China from 2011 to 2014 were included in the study. The fixed radius approach with GIS information was employed to define hospital market, and the differences in competition over time and across regions were utilized. Our analysis is based on the fixed effect estimation, which accounts for the time-invariant unobserved heterogeneity among hospitals.

Results

We found an inversed U-shaped relationship between HHI and the likelihood of medical disputes. As beneath either situation of monopoly or full competition, the burst of physician-patient dispute was downward into a valley, but it rises and then falls again with the increase of HHI, it reached the peak at the typical semi-market hospital competition structure.

Conclusions

Our results highlight the probability of change in disputes occurrence with the transition of hospital competition and its psychological explanation, providing implications for China’s future health reform.
Footnotes
1
Fixed radius approach is a proper index to define the hospital market. It not only had the strength of healthcare utilization feature consideration, but also overcome the drawbacks of definitions based on geopolitical boundaries. Under the fixed radius approach, every hospital was assigned a unique market area, which is the region enclosed by a circle centered on the hospital and defined by a fixed radius. The fixed radius approach has the advantage of including a hospital’s nearby competitors, even when they are located on the other side of a political boundary.
 
2
The latitude and longitude of hospital locations were geocoded using the hospital names and addresses [40].
 
3
According to our statistical analysis, no matter the hospital is designated as the hospital for public health insurance or not, the regression results is always solid. If readers are interested in our data, we could provide it upon request.
 
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Metadata
Title
Control under times of uncertainty: the relationship between hospital competition and physician-patient disputes
Authors
Qian Yang
Jay Pan
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0701-0

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