Peng Zixuan, Laporte Audrey, Wei Xiaolin, Pan Jay, Coyte Peter C
School of Public Health, Southeast University, Nanjing, China.
Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Health Syst Reform. 2025 Dec 31;11(1):2507975. doi: 10.1080/23288604.2025.2507975. Epub 2025 Jun 9.
It is already a common practice for many health care systems in the world to opt for mixed markets where different types of health care facilities compete against each other to offer high-quality health care to patients. Nevertheless, little is known about the effects of the interaction between hospitals of the same or different type on patient health outcomes. This study estimated the impacts of aggregate and specific types of hospital competition by hospital-type on the quality of inpatient care using an analysis dataset comprising 267,183 individuals from China. The Herfindahl-Hirschman index was employed to measure the degree of hospital competition, with length of stay, readmission and mortality being used to measure the quality of inpatient care. The Poisson and binomial logistic models combined with the instrumental variable approach were constructed to estimate the impacts of hospital competition. This study generated three key findings: 1) aggregate hospital competition reduced the quality of inpatient care, as evidenced by a rise in the odds of readmission and length of stay; 2) intra-type hospital competition reduced the quality of inpatient care and in general had larger effects on reducing the quality of inpatient care than inter-type hospital competition; and 3) the only exception was in the way that competition between private nonprofit hospitals contributed to better quality of inpatient care. The overarching suggestion is that instead of treating competition as a panacea for improving health, a flexible plan tailored to specific conditions is needed.
对于世界上许多医疗保健系统而言，选择不同类型的医疗保健机构相互竞争，以向患者提供高质量医疗服务的混合市场模式，已是一种常见做法。然而，关于同类型或不同类型医院之间的相互作用对患者健康结果的影响，我们却知之甚少。本研究使用一个包含来自中国的267,183人的分析数据集，估计了总体和特定类型的医院竞争（按医院类型划分）对住院护理质量的影响。采用赫芬达尔-赫希曼指数来衡量医院竞争程度，并用住院时间、再入院率和死亡率来衡量住院护理质量。构建了泊松模型和二项逻辑模型，并结合工具变量法来估计医院竞争的影响。本研究得出了三个关键发现：1）总体医院竞争降低了住院护理质量，再入院几率和住院时间的增加证明了这一点；2）同类型医院之间的竞争降低了住院护理质量，总体而言，其对降低住院护理质量的影响大于不同类型医院之间的竞争；3）唯一的例外是私立非营利医院之间的竞争有助于提高住院护理质量。总体建议是，不应将竞争视为改善健康的万灵药，而是需要制定一个针对具体情况的灵活计划。
