School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
West China School of Public Health, Sichuan University, Chengdu, China.
Int J Equity Health. 2017 Nov 28;16(1):205. doi: 10.1186/s12939-017-0701-0.
Recently, cases of medical disputes and even acts of violence toward physicians by patients in China have been escalating. It remains unknown whether competition improves the patient-physician relationship.
This paper analyzes the relationship between hospital competition and the probability of medical disputes occurrence according to the theory of social control. Data from all hospitals in the Sichuan province of China from 2011 to 2014 were included in the study. The fixed radius approach with GIS information was employed to define hospital market, and the differences in competition over time and across regions were utilized. Our analysis is based on the fixed effect estimation, which accounts for the time-invariant unobserved heterogeneity among hospitals.
We found an inversed U-shaped relationship between HHI and the likelihood of medical disputes. As beneath either situation of monopoly or full competition, the burst of physician-patient dispute was downward into a valley, but it rises and then falls again with the increase of HHI, it reached the peak at the typical semi-market hospital competition structure.
Our results highlight the probability of change in disputes occurrence with the transition of hospital competition and its psychological explanation, providing implications for China's future health reform.
最近，中国的医疗纠纷案件甚至出现了患者对医生的暴力行为，呈上升趋势。目前尚不清楚竞争是否会改善医患关系。
本文根据社会控制理论，分析了医院竞争与医疗纠纷发生概率之间的关系。研究纳入了 2011 年至 2014 年中国四川省所有医院的数据。采用 GIS 信息的固定半径方法来定义医院市场，并利用时间和地区之间的竞争差异。我们的分析基于固定效应估计，考虑了医院之间不可观测的时间不变异质性。
我们发现 HHI 与医疗纠纷发生的可能性之间呈倒 U 型关系。在垄断或完全竞争的情况下，医患纠纷都会呈下降趋势，但随着 HHI 的增加，它会先上升后下降，在典型的半市场医院竞争结构中达到峰值。
我们的结果强调了医院竞争的转变及其心理解释对纠纷发生概率的影响，为中国未来的卫生改革提供了启示。
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