The Effect Of Hospital Market Competition On Medical Quality

[Purpose] This study aims to understand the status quo of markt competition for inpatients with vertebrae peration in China,explores the association between hospital market competition and medical quality,and provide empirical evidence for health administrators and health policy makers to improve medical quality with market mechanism in China.[Methods] Data sources:(1)Literature databases: related literature concerning the association between hospital market competition and medical quality from international and domestic databases.(2)Brief electronic medical records in Shanxi(48365 inpatients with cervical vertebrae surgery from 44 hospitals,19070 inpatients with thoracic vertebrae surgery from 38 hospitals and 41190 inpatients with lumbar vertebrae surgery from 43 hospitals);(3)Operational data of sample hospitals: sample hospitals location,grade,level,number of open beds,areas,longitude and latitude.Methodologies:(1)Literature analysis: to define the key terms and expressions used in this study,and systematically understand the frontier methods,indicators and models in this field;(2)secondary data analysis: the spatial distribution,scale and volumn of sample hospitals were analyzed with secondary data analysis;(3)descriptive analysis:descriptive statistics were calculated for four competition measures used in this study;(4)rare events logistic regression model.All data cleaning,statistical analysis and modeling are performed in statistical environment R 3.3.1.[Results](1)Pearson correlation coefficients were 0.579,0.562 and 0.538 between competition index via fix radius method and variable radius method for the three patients.Pearson correlation coefficients were 0.311 and 0.443 between competition index calculated via predicted patient flow and actual patient flow for cervical vertebrae surgery and lumbar vertebrae surgery patients.However,the correlation between competition index calculated via patient flow and radius was nominal,with Pearson correlation coefficients typically below 0.2.(2)The effects of market competition on death during admission for the three kinds of patients were in the same direction,and odds ratios are 3.979(p<0.001),6.66(p<0.001)and 1.61(p=0.340)respectively,which indicates that market competition is positively related with death within admission.[Conclusions] The effect of market competition on medical quality is inconsistent with the variation of surgeries,different categories of competition measures and medical quality measures.There is fair amount of competition in Chinese hospital market.Healthcare administrators and policy makers should not focus on ways to introduce and improve competition,but on how to convert hospital competition into positive outcomes.