The Effects of Market Competition on Hospital Performance: Does it Lead to Better Heart Failure Care?
Year: 2010
Type: preprint
Abstract: Hospital performance measurement initiatives have been gaining popularity in recent years. Although there has been a reported increase in the performance of hospitals on standardized quality indicators for some of the most common medical conditions, little is known if market competition is a potential driver of this phenomenon. The objective of this study was to investigate whether hospital market competition is associated with an increased compliance on several key evidence-based heart failure quality indicators: 1) ACE inhibitor/angiotensin receptor blocker prescribed at discharge, 2) left ventricular function assessment, 3) discharge instructions, and 4) smoking cessation counseling.The primary data come from The Joint Commission’s ORYX hospital performance data from Quarter 1 of 2003 through Quarter 4 of 2006. Healthcare markets were defined as hospital referral regions (HRRs) according to the crosswalk methodology of the Dartmouth Atlas of Health Care and market competition intensity was defined by the Herfindahl-Hirschman Index. Descriptive statistics and bivariate analyses were initially performed. We study a total of 3,101 Joint Commission-accredited acute care hospitals that participated in the ORYX program were aggregated to 306 hospital referral regions across the United States from Quarter 1 of 2003 through Quarter 4 of 2006 (n=4,896). An ordinary least squared (OLS) fixed-effects regression model was estimated to estimate the relationship between market competition and HRR performance on each of the four heart failure quality indicators. In addition to controlling for time-invariant HRR-level unobservables through the fixed effects, the multivariate analyses also adjust for hospital, socio-demographic, and market-level characteristics. Our results indicate that on average HRR performance for each of the heart failure quality indicators increased over the study period from baseline (p
Source: SSRN Electronic Journal
Author: Jared Lane Maeda
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W1669915250