Department of Health Care Management, Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Str. des 17. Juni 135, 10623, Berlin, Germany.
City University London, Northampton Square, Clerkenwell, London, EC1V 0HB, UK.
Eur J Health Econ. 2019 Feb;20(1):163-174. doi: 10.1007/s10198-018-0990-2. Epub 2018 Jul 2.
Competition in hospital services has been fostered in an increasing number of OECD countries with the goal that hospitals improve quality and/or efficiency. With the same intention competition has been promoted in Germany when introducing a system of prospective payments based on diagnosis-related groups (DRGs) in 2003. Beyond its intended effects, however, the reform led to a substantial increase in hospital activity, particularly for orthopaedic surgery. To shed more light on these developments, this paper analyses the relationship between the rates of certain orthopaedic surgical procedures and hospital competition across and within each of Germany's 402 districts. We measured competition with the Herfindahl-Hirschman Index (HHI) based on market shares for hip replacements, knee replacements and spine surgeries. Using spatial panel regression, which allows for spatial dependency and unobserved individual heterogeneity, we found that the rate of hip and knee replacements rose as market concentration increased. A potential explanation might be that hospitals specialize in these particular procedures.
在越来越多的经合组织国家中，医院服务的竞争得到了促进，目的是提高医院的质量和/或效率。2003 年，德国在引入基于疾病相关分组（DRG）的预付款制度时，也有同样的意图来促进竞争。然而，除了预期的效果之外，改革导致医院活动大幅增加，特别是在骨科手术方面。为了更清楚地了解这些发展，本文分析了德国 402 个地区之间和内部某些骨科手术程序的比率与医院竞争之间的关系。我们使用基于髋关节置换术、膝关节置换术和脊柱手术市场份额的赫芬达尔-赫希曼指数（HHI）来衡量竞争。使用空间面板回归，允许空间相关性和未观察到的个体异质性，我们发现髋关节和膝关节置换术的比率随着市场集中程度的增加而上升。一个可能的解释是医院专门从事这些特定的程序。
