Work

The impact of hospital competition on healthcare quality: evidence from China’s healthcare reform

Year: 2025

Type: article

Abstract: Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2025.1543884

Authors: Huimin Liu, Junyan Jiang, Liangchun Yu, Xianpeng Liu

Institutions: Jiangxi University of Science and Technology, Shandong University

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801