Hospital Competition, Technical Efficiency and Quality

Competition has been widely introduced among hospitals in the hope of improving health-care quality. However, whether competition leads to higher-quality health care is a topic of considerable debate. We conducted a systematic review to assess the impact of hospital-market competition on unplanned readmission. We searched six electronic databases (PubMed, EmBase, Wiley Online Library, Web of Science, Scopus, and JSTOR) and reference lists of screened articles for relevant studies, and strictly followed methods proposed by the Cochrane Collaboration. Finally, nine observational studies with 2,241,767 patients were included. For the primary outcome, pooled results of three studies showed that it was uncertain whether or not hospital competition reduces readmission ( β =0.02, P=0.06; very low certainty of evidence, as they were all observational studies with high heterogeneity). Inconsistent results were found in the remaining six studies, and they were assessed as very low–certainty evidence, downgraded for either inconsistency or indirectness or both. As for secondary outcomes, seven of the nine studies reported on the impact of competition on the risk of mortality, and two reported on length of stay (LOS). It was uncertain whether competition had an effect on mortality or LOS. The relevant studies were limited and of very low certainty, which means there is currently no reliable evidence showing that hospital competition reduces quality of health care in terms of readmission/mortality/LOS. There is a need for rigorous studies to assess the impact of hospital competition on the quality of health care.

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“… 53–55 The other two papers did not study the relationship between competition and hospital quality ( Table 2 ). 56 , 57 …”

Section: Resultsmentioning

confidence: 99%

Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review

Jiang

Tian

Liu

et al. 2021

RMHP

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“…6,30,31 Bates et al 6 analyzed how market structure, measured by competition among rivals, presence of HMOs, and the buying power of health insurers, affects the level of technical efficiency in the hospital service industry. They did not find evidence that greater rivalry increases technical efficiency.…”

Section: Hospital Competition and Efficiencymentioning

confidence: 99%

Has Competition Increased Hospital Technical Efficiency?

Lee

Lim

Park

2015

The Health Care Manager

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Hospital competition and managed care have affected the hospital industry in various ways including technical efficiency. Hospital efficiency has become an important topic, and it is important to properly measure hospital efficiency in order to evaluate the impact of policies on the hospital industry. The primary independent variable is hospital competition. By using the 2001-2004 inpatient discharge data from Florida, we calculate the degree of hospital competition in Florida for 4 years. Hospital efficiency scores are developed using the Data Envelopment Analysis and by using the selected input and output variables from the American Hospital Association's Annual Survey of Hospitals for those acute care general hospitals in Florida. By using the hospital efficiency score as a dependent variable, we analyze the effects of hospital competition on hospital efficiency from 2001 to 2004 and find that when a hospital was located in a less competitive market in 2003, its technical efficiency score was lower than those in a more competitive market.

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“…However, in the market for hospital services, it is unclear whether hospital competition enhances hospital efficiency . Some studies have found that when a hospital was located in a highly competitive market, its efficiency score was higher than the scores of hospitals in a less competitive market . Other studies have reported no evidence that increasing the degree of competition among hospitals increases technical efficiency …”

Section: Theoretical Foundation/conceptual Modelmentioning

confidence: 99%

Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units

Min

Scott

Park

et al. 2018

Health Planning & Management

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This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors.

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Hospital Competition, Technical Efficiency and Quality

Cited by 18 publications

References 50 publications

Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review

Hospital Competition and Unplanned Readmission: Evidence from a Systematic Review

Has Competition Increased Hospital Technical Efficiency?

Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units

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