Department of Economics and Related Studies, University of York, Heslington, York YO10 5DD, UK.
Department of Economics/NIPE, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; Department of Economics, University of Bergen, Norway.
J Health Econ. 2019 Mar;64:1-14. doi: 10.1016/j.jhealeco.2018.12.002. Epub 2018 Dec 21.
We provide a model where hospitals compete on quality under fixed prices to investigate how hospital competition affects (i) quality differences between hospitals, and as a result, (ii) health inequalities across hospitals and patient severities. The answer to the first question is ambiguous and depends on factors related to both demand and supply of health care. Whether competition increases or reduces health inequalities depends on the type and measure of inequality. Health inequalities due to the postcode lottery are more likely to decrease if the marginal health gains from quality decrease at a higher rate, whereas health inequalities between high- and low-severity patients decrease if patient composition effects are sufficiently small. We also investigate the effect of competition on health inequalities as measured by the Gini and the Generalised Gini coefficients, and highlight differences compared to the simpler dispersion measures.
我们提供了一个模型，其中医院在固定价格下竞争质量，以研究医院竞争如何影响（i）医院之间的质量差异，以及由此导致的（ii）医院之间的健康不平等和患者严重程度的差异。第一个问题的答案是不确定的，取决于与医疗保健的需求和供应有关的因素。竞争是否会增加或减少健康不平等取决于不平等的类型和衡量标准。如果质量提高带来的边际健康收益下降速度更快，那么由于邮政编码彩票导致的健康不平等更有可能减少，而如果患者构成效应足够小，那么高低严重程度患者之间的健康不平等就会减少。我们还研究了竞争对基尼系数和广义基尼系数衡量的健康不平等的影响，并强调了与更简单的离散度衡量标准相比的差异。
