Spatial competition and quality: Evidence from the English family doctor market

Abstract

Background to series CHE Discussion Papers (DPs) began publication in 1983 as a means of making current research material more widely available to health economists and other potential users. So as to speed up the dissemination process, papers were originally published by CHE and distributed by post to a worldwide readership. The CHE Research Paper series takes over that function and provides access to current research output via web-based publication, although hard copy will continue to be available (but subject to charge).

Patient choice, entry, and the quality of primary care: Evidence from Swedish reforms

“…We present several pieces of evidence suggesting that the reforms had limited effect on patients' access to care, leaving increased competition as the most likely mechanism behind the results. Our results are in line with the small literature examining the causal effects of competition on primary care quality in markets with regulated prices (Gravelle et al, ).…”

“…The small empirical literature on quality effects of patient choice and competition in primary care settings with regulated prices suffers from a lack of exogenous variation (e.g., Berlin, Busato, Rosemann, Djalali, & Maessen, ; Jürges & Pohl, ; Pike, ; Rosano et al, ; Stroka‐Wetsch, Talmann, & Linder, ). In the most convincing study (Gravelle, Liu, Propper, & Santos, ), the main specification relies on GP practice fixed effects (FEs) and thus accounts for unobserved (geographical or demographic) common determinants of choice, competition, and quality but not for the endogeneity of entries and exits. The study finds small increases in patient satisfaction but no strong indications that competition improves objective quality measures (e.g., avoidable hospitalisation rates).…”

What drives general practitioners in the UK to improve the quality of care? A systematic literature review

“…Gravelle et al studied 8000 practices over 8 years and observed that increased local competition, defined as the number of rival GPs within a given radius, resulted in improved quality of care, as measured by QOF indicators and patient satisfaction. 38 However, the increased number of GPs does not necessarily imply an increase in competition if there is a concomitant increase in demand due to greater population density. Furthermore, the overall effect of competition was concluded to be small in comparison to the impact of both financial and non-financial incentives.…”

The Effect of Interdependences of Referral Behaviors on the Quality of Ambulatory Care: Evidence from Taiwan

“…11 Similar to these two meta-analysis studies focusing on the linkage between hospital competition and quality of inpatient care, recent empirical studies found the effect of market competition on quality of healthcare in various healthcare markets to be positive in the homecare market, 12 negative in the physiotherapy and nursing home markets, 13,14 and inconsistent in the primary care market. 15,16 It is important to address that the aforementioned studies exploring the impact of market competition on the quality of healthcare applied to a single competition indicator (such as the Herfindahl-Hirschman index) to measure market competition. Nevertheless, the major shortcoming of using a single competition indicator for measuring market competition is that this ignores the fact that interdependences of healthcare providers' behaviors are the underlying mechanism of market competition.…”

“…It follows that most of the previous studies investigating the connection between a single competition indicator and the quality of healthcare failed to model the interdependences of healthcare providers' behaviors (constituting a central role in market competition) and regarded the underlying mechanism of market competition processing the quality of healthcare as a black box. [10][11][12][13][14][15][16] In order to establish the linkage between the underlying mechanism of market competition and quality of healthcare, three research questions of this study were proposed as follows: First, whether or not the relationship between the underlying mechanism of market competition and quality of healthcare could be established. Second, how do we model competition and collaboration between hospitals and local clinics and evaluate their impact on the quality of ambulatory care?…”