West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, 610041, China.
Health Care Manag Sci. 2021 Sep;24(3):582-596. doi: 10.1007/s10729-020-09529-x. Epub 2021 Jan 7.
With the implementation of a series of pro-competition policies in China, the hospital market competition has been intensified dramatically over the past decade. Based on previous literature, such competition is very much likely to bring about an upgoing trend in the promotion and expansion of medical facilities among hospitals as an essential strategy for attracting patients, which is known as Medical Arms Race (MAR). Comprehensive evaluations have been conducted by previous studies on the consequences of the MAR, which, however, merely provided inadequate empirical evidence on the relationship between hospital competition and MAR. Utilizing the variations in hospital competition across various regions and through different time periods in Sichuan Province as a prototype representative of the nationwide situation, a dynamic panel data model was established and adopted in this study for investigating whether intensified hospital competition had resulted in the expansion of medical facilities in China during the corresponding time period. The geopolitical boundaries and Herfindahl-Hirschman Index (HHI) were respectively employed to define the hospital market and measure the competition degree. We found that a 10% reduction in HHI is associated with an 8.79% increase in regional total costs of advanced medical equipment per capita, suggesting that hospital competition would lead to medical equipment expansion. Our results provide novel evidence on MAR which is particularly applicable for the healthcare system in China, providing suggestions for nationwide healthcare reform in order to mitigate potential negative outcomes induced by the implementation of pro-competition policies.
随着中国一系列促进竞争的政策的实施，过去十年间医院市场竞争激烈程度显著加剧。基于以往的文献，这种竞争很可能导致医院作为吸引患者的必要策略，掀起医疗设施的推广和扩张的热潮，即医疗军备竞赛（MAR）。以往的研究对 MAR 的后果进行了综合评估，但仅提供了关于医院竞争与 MAR 之间关系的证据不足。本研究利用四川省不同地区和不同时期医院竞争的变化作为全国情况的典型代表，建立并采用动态面板数据模型，调查在相应时期，加剧的医院竞争是否导致了中国医疗设施的扩张。地缘政治边界和赫芬达尔-赫希曼指数（HHI）分别用于定义医院市场和衡量竞争程度。我们发现 HHI 降低 10%，人均区域先进医疗设备总成本增加 8.79%，这表明医院竞争将导致医疗设备扩张。我们的研究结果为 MAR 提供了新的证据，这对中国的医疗保健系统尤为适用，为全国性的医疗改革提供建议，以减轻实施促进竞争政策所带来的潜在负面影响。
