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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Prostatectomy | Research article

Hospital competition and the expenses for treatments of acute and non-acute common diseases: evidence from China

Authors: Chenhui Deng, Jay Pan

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Because there is heterogeneity in disease types, competition among hospitals could be influenced in various ways by service provision for diseases with different characteristics. Limited studies have focused on this matter. This study aims to evaluate and compare the relationships between hospital competition and the expenses of prostatectomies (elective surgery, representing treatments of non-acute common diseases) and appendectomies (emergency surgery, representing treatments of acute common diseases).

Methods

Multivariable log-linear models were constructed to determine the association between hospital competition and the expenses of prostatectomies and appendectomies. The fixed-radius Herfindahl-Hirschman Index was employed to measure hospital competition.

Results

We collected data on 13,958 inpatients from the hospital discharge data of Sichuan Province in China from September to December 2016. The data included 3578 prostatectomy patients and 10,380 appendectomy patients. The results showed that greater competition was associated with a lower total hospital charge for prostatectomy (p = 0.006) but a higher charge for appendectomy (p <  0.001). The subcategory analysis showed that greater competition was consistently associated with lower out-of-pocket (OOP) and higher reimbursement for both surgeries.

Conclusions

Greater competition was significantly associated with lower total hospital charges for prostatectomies, while the opposite was true for appendectomies. Furthermore, greater competition was consistently associated with lower OOP but higher reimbursement for both surgeries. This study provides new evidence concerning the heterogeneous roles of competition in service provision for non-acute and acute common diseases. The findings of this study indicate that the pro-competition policy is a viable option for the Chinese government to relieve patients’ financial burden (OOP). Our findings also provide references and insights for other countries facing similar challenges.
Footnotes
1
Except for the two surgeries reported in the main text, we also analyzed two other elective surgeries (ligation of hemorrhoids and excision of pterygium) and two emergency surgeries (reduction of humeral fracture and inguinal hernia repair) for robust tests. The estimations of the four surgeries showed a similar trend to our main analysis. Considering the emergency conditions of the excision of pterygium, the reduction of humeral fracture, and the inguinal hernia repair could not be identified as clearly as prostatectomy and appendectomy, while the inpatient surgery of the ligation of hemorrhoids is mixed with the day surgery in our database. Therefore, we did not include them in the main text. The results are available upon request.
 
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Metadata
Title
Hospital competition and the expenses for treatments of acute and non-acute common diseases: evidence from China
Authors
Chenhui Deng
Jay Pan
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4543-x

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