<p>Perceived Competition and Process of Care in Rural China</p>

Abstract

Purpose: Although there is much debate about the effect of hospital competition on healthcare quality, its impact on the process of care remains unclear. This study aimed to determine whether hospital competition improves the process of care in rural China. Patients and Methods: The county hospital questionnaire survey data and the randomly sampled medical records of bacterial pneumonia patients in 2015 in rural area of Guizhou, China, were used in this study. The processes of care for bacterial pneumonia were measured by the following three measures: 1) oxygenation assessment, 2) antibiotic treatment, and 3) first antibiotic treatment within 6 hours after admission. Hospital competition was measured by asking hospital directors to rate the competition pressure they perceive from other hospitals. Multivariate logistic regression models were employed to determine the relationship between perceived competition and the processes of care for patients with bacterial pneumonia. Results: A total of 2167 bacterial pneumonia patients from 24 county hospitals in 2015 were included in our study. Our results suggested that the likelihood of receiving antibiotic treatment and first antibiotic treatment within 6 hours after admission was significantly higher in the hospitals perceiving higher competition pressure. However, no significant relationship was found between perceived competition and oxygenation assessment for patients with bacterial pneumonia. Conclusion: This study revealed the role of perceived competition in improving the process of care under the fee-for-service payment system and provided empirical evidence to support the pro-competition policies in China's new round of national healthcare reform.

Quality of Care in Public County Hospitals: A Cross-Sectional Study for Stroke, Pneumonia, and Heart Failure Care in Eastern China

“…Although, as mentioned above, studies on the process dimension of QoC in China are very few, we still identified 2 possible relevant studies. Lin conducted a study on the quality of pneumonia care of 24 hospitals across southwestern China and utilized 3 QoC indicators: (1) oxygenation assessment, (2) antibiotic treatment, and (3) first antibiotic treatment within 6 h after admission [ 37 ], of which 2 are the same as our study. As estimated by Lin, 2.3% of the included pneumonia patients received blood oxygenation assessment, which in our study was 34.04%, and 91.1% received first antibiotic treatment within 6 h after admission [ 37 ], which in our study was 88.75%.…”

“…Lin conducted a study on the quality of pneumonia care of 24 hospitals across southwestern China and utilized 3 QoC indicators: (1) oxygenation assessment, (2) antibiotic treatment, and (3) first antibiotic treatment within 6 h after admission [ 37 ], of which 2 are the same as our study. As estimated by Lin, 2.3% of the included pneumonia patients received blood oxygenation assessment, which in our study was 34.04%, and 91.1% received first antibiotic treatment within 6 h after admission [ 37 ], which in our study was 88.75%. Although the latter indicator in southwestern China seems a bit better than that in eastern China, the former indicator suggests great differences between the 2 places.…”

Director’s Perceived Competition and Its Relationship with Hospital’s Competitive Behaviors: Evidence from County Hospitals in China

“…Only 8 respondents (3.7%) reported the absence of perceived competition. Based on previous research, 43 “no competition” and “moderate competition” were defined as low competition groups (as references) with an assigned value of zero, and “intense competition” was defined as the high competition group with an assigned value of one. Directors who reported the perception of intense competition or moderate competition were further asked about where the competition pressure mainly came from, which included multiple potential sources namely hospitals out of the county, public hospitals within the county, private hospitals within the county, or other.…”