Does competition between hospitals improve the quality of care? - Hospital death rates and the NHS internal market

• 成果类型: Article
• 署名作者: Propper, C; Burgess, S; Green, K
• 署名单位: University of Bristol
• 刊物名称: JOURNAL OF PUBLIC ECONOMICS
• ISSN/ISSBN: 0047-2727
• DOI: 10.1016/S0047-2727(02)00216-5
• 发表日期: 2004
• 页码: 1247-1272
• 关键词: competition; health care; mortality; quality of care

摘要

Payer-driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. Using data that until 1999 were not publicly available in any form on hospital level death rates, we find that the relationship between competition and quality of care appears to be negative. Greater competition is associated with higher death rates, controlling for patient mix and other observed characteristics of the hospital and the catchment area for its patients. However, the estimated impact of competition is small. (C) 2003 Elsevier B.V. All rights reserved.