Choice and Competition Between Adult Congenital Heart Disease Centers

Abstract

Background-Although concentrating adult congenital heart disease services at high-volume centers has been widely advocated, the potential beneficial effects of competition and patient choice have received relatively little attention. We aimed to assess the degree of patient choice and competition between adult congenital heart disease units and to investigate whether competition indices correlate with clinical quality or research output. Methods and Results-Competition between the 10 major adult congenital heart disease units in England was evaluated based on the Herfindahl-Hirschman Index, representing the sum of squared market shares of individual units. In addition, to account for geography and feasible access, we calculated spatial indices of competition based on travel time by road. These indices were correlated with 30-day mortality postpulmonary valve replacement in adult patients (as obtained from the National Central Cardiac Audit Database) and the aggregate research impact factors of individual centers. On a national level, a high level of competition without obvious dominant players was found (Herfindahl-Hirschman Index between 0.107 and 0.013). When accounting for geography, however, important disparities in patient choice and competition faced by individual centers emerged. The degree of local competition was correlated significantly with clinical outcomes and research output. In contrast, no association between center volume and outcome could be established. Conclusions-Beyond the usual focus on concentrating services at high-volume centers, the potentially beneficial effects of competition should not be ignored. Therefore, policymakers should consider fostering a competitive environment for adult congenital heart disease centers or at least avoiding creating government-granted monopolies in the field.(Circ Cardiovasc Qual Outcomes. 2014;7:285-291.)

Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study

“… 58 Studies across other specialties have shown mixed results for the effect of fixed-price markets on improvements in health-care quality. 8 , 23 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 …”

“…For each surgical centre we calculated a spatial competition index (SCI) as a measure of external competition. 22 , 23 The SCI provides a uniform metric that can be used across all surgical centres and that represents the demand for services and the availability of alternative hospitals. Across England, there is variation in the concentration of available hospitals depending on the degree of urbanisation or rurality.…”

Geographic accessibility and hospital competition for emergency blood transfusion services in Bungoma, Western Kenya

“…Although it is rarely considered when establishing transfusion centres, spatial competition is potentially a driver in blood provision. Highly competitive facilities have also been linked to improved clinical outcomes for adult congenital heart disorders in [ 54 ], highlighting the importance of taking spatial competition into account in future research. However, our study used a small sample size of transfusing facilities hence future research could explore spatial competition with an increased sample size preferably a nation-wide coverage.…”

“…The degree of spatial competition in the county healthcare market was defined within facility catchment constrained to 1-h travel time, optimal for emergency BT patients [ 54 ]. Spatial competition index (SCI) was computed for each facility to represent the level of service demand and availability of alternative facilities within the defined facility catchment.…”

Lifespan Perspective on Congenital Heart Disease Research

“…Improving access to specialized CHD care is another important measure of quality particularly for people living in remote areas. Even among high income countries, there are significant geographic disparities in accessing specialized CHD healthcare (73,74). In middle-and low income countries, the problem tends to be even greater, since allocated resources are limited, despite the growing number of children born with CHD requiring specialized care (75).…”