Liu Huimin, Jiang Junyan, Yu Liangchun, Liu Xianpeng
School of Economics and Management, Jiangxi University of Science and Technology, Ganzhou, China.
School of Economics, Shandong University, Jinan, China.
Front Public Health. 2025 May 30;13:1543884. doi: 10.3389/fpubh.2025.1543884. eCollection 2025.
Hospital competition has been a common feature in healthcare reforms worldwide, yet scant attention has been paid to its impact on healthcare quality in China. This study aims to comprehensively evaluate the impact of hospital competition on healthcare quality under China's healthcare reform.
This study used multiple datasets comprising city-level and individual-level data of 21,974 individuals across 150 districts. We employed a two-way fixed effects model to estimate the impact of hospital competition on healthcare quality. To mitigate endogeneity concerns, we instrumented hospital competition with the inverse of the average distance and average travel time from patients to hospitals and performed the Two-Stage Least Squares methods.
This study showed a positive effect of hospital competition on both technical and non-technical healthcare quality. The impact is larger for primary hospitals and inpatient services; it is significantly positive for technical healthcare quality in public hospitals. Additionally, our findings implied that hospital competition affects healthcare income, which in turn affects non-technical healthcare quality, but healthcare income and demand jointly influence the relationship between hospital competition and technical healthcare quality.
The finding provides new evidence of the impact of hospital competition on both technical and non-technical healthcare quality in China, highlighting a positive relationship that differs from some previous studies. This evidence offers valuable policy implications on hospital competition and also emphasizes the importance of considering the heterogeneity of hospitals and services in policy-making.
医院竞争一直是全球医疗改革的一个共同特征，但在中国，其对医疗质量的影响却很少受到关注。本研究旨在全面评估中国医疗改革背景下医院竞争对医疗质量的影响。
本研究使用了多个数据集，包括150个地区21974个人的城市层面和个体层面数据。我们采用双向固定效应模型来估计医院竞争对医疗质量的影响。为了减轻内生性问题，我们用患者到医院的平均距离和平均出行时间的倒数作为医院竞争的工具变量，并采用两阶段最小二乘法。
本研究表明医院竞争对技术和非技术医疗质量均有积极影响。对基层医院和住院服务的影响更大；对公立医院的技术医疗质量有显著的积极影响。此外，我们的研究结果表明，医院竞争影响医疗收入，进而影响非技术医疗质量，但医疗收入和需求共同影响医院竞争与技术医疗质量之间的关系。
该研究结果为中国医院竞争对技术和非技术医疗质量的影响提供了新的证据，突出了与以往一些研究不同的正向关系。这一证据为医院竞争提供了有价值的政策启示，也强调了在政策制定中考虑医院和服务异质性的重要性。
