Norwegian School of Economics (NHH), Department of Economics, Helleveien 30, 5045 Bergen, Norway; Centre for Applied Research at NHH(SNF).
TBS Business School, 1M Place Alphonse Jourdain, 31068 Toulouse, France.
J Health Econ. 2021 Sep;79:102509. doi: 10.1016/j.jhealeco.2021.102509. Epub 2021 Jul 23.
We study the impact of exposing hospitals in a National Health Service (NHS) to non-price competition by exploiting a patient choice reform in Norway in 2001. The reform facilitates a difference-in-difference approach due to plausibly exogenous (geographical) variation in pre-reform market structure. Employing rich, administrative data, covering the universe of hospital admissions from 1998 to 2005, we estimate models with hospital and treatment (DRG) fixed-effects and use only emergency admissions to limit patient selection issues. The results show that hospitals in more competitive areas have a sharper reduction in AMI mortality but no effect on stroke mortality. We also find that exposure to competition reduces all-cause mortality, shortens length of stay, but increases readmissions, though the effects are small in magnitude. In years with high (DRG) prices, the negative effect on readmissions almost vanishes. Finally, exposure to competition tends to reduce waiting times and increase admissions, but the effects must be interpreted with care as the outcomes include elective treatments.
我们研究了在国家卫生服务（NHS）中通过引入患者选择改革来使医院面临非价格竞争的影响，该改革在 2001 年在挪威实施。该改革为我们提供了一种双重差分法的可能性，因为在改革前的市场结构中存在合理的外生（地理）变化。我们利用丰富的行政数据，涵盖了 1998 年至 2005 年的所有住院治疗数据，使用仅包括急诊入院的模型来限制患者选择问题，并对医院和治疗（DRG）固定效应进行了估计。结果表明，在竞争更为激烈的地区的医院中，AMI 死亡率下降幅度更大，但对中风死亡率没有影响。我们还发现，竞争的加剧降低了所有原因的死亡率，缩短了住院时间，但增加了再次入院率，尽管其影响幅度较小。在（DRG）价格较高的年份，对再次入院率的负面影响几乎消失。最后，竞争的加剧往往会减少等待时间并增加入院率，但由于这些结果包括选择性治疗，因此必须谨慎解释这些效果。
