Rotterdam School of Management, Erasmus University, Rotterdam, The Netherlands.
Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
Eur J Health Econ. 2023 Aug;24(6):999-1017. doi: 10.1007/s10198-022-01529-8. Epub 2022 Oct 4.
Many countries have introduced competition among hospitals aiming to improve their performance. We evaluate the introduction of competition among hospitals in the Netherlands over the years 2008-2015. The analysis is based on a unique longitudinal data set covering all Dutch hospitals and health insurers, as well as demographic and geographic data. We measure hospital performance using Data Envelopment Analysis and distinguish three components of competition: the fraction of freely negotiated services, market power of hospitals, and insurer bargaining power. We present new methods to define variables for each of these components which are more accurate than previously developed measures. In a multivariate regression analysis, the variables explain more than half of the variance in hospital efficiency. The results indicate that competition between hospitals and the relative fraction of freely negotiable health services are positively related to hospital efficiency. At the same time, the policy measure to steadily increase the fraction of health services contracted in competition may well have resulted in a decrease in hospital efficiency. The models show no significant association between insurer bargaining power and hospital efficiency. Altogether, the results offer little evidence that the introduction of competition for hospital care in the Netherlands has been effective.
许多国家已经引入了医院之间的竞争，旨在提高它们的绩效。我们评估了 2008 年至 2015 年间荷兰医院之间竞争的引入。该分析基于一个涵盖所有荷兰医院和健康保险公司以及人口统计和地理数据的独特纵向数据集。我们使用数据包络分析衡量医院的绩效，并区分竞争的三个组成部分：自由协商服务的比例、医院的市场力量和保险公司的议价能力。我们提出了新的方法来为每个组成部分定义变量，这些变量比以前开发的衡量标准更准确。在多元回归分析中，这些变量解释了医院效率变化的一半以上。结果表明，医院之间的竞争以及自由协商医疗服务的相对比例与医院效率呈正相关。同时，稳步增加竞争中签约医疗服务比例的政策措施可能导致医院效率下降。该模型显示保险公司议价能力与医院效率之间没有显著关联。总的来说，结果几乎没有证据表明荷兰引入医院护理竞争是有效的。
