ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2017
Competition in the Dutch hospital sector: an analysis of health care volume and cost.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed.
- The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB-IIC Patients-Results After 3 Years.Annals of surgical oncology · 2020Trial
- Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city.Health economics review · 2024Article
- Successes and challenges of China's health care reform: a four-decade perspective spanning 1985-2023.Cost effectiveness and resource allocation : C/E · 2023Review
- Association between hospital competition and quality of prostate cancer care.BMC health services research · 2023Article
- Does competition improve hospital performance: a DEA based evaluation from the Netherlands.The European journal of health economics : HEPAC : health economics in prevention and care · 2023Article
- Improving Performance in Complex Surroundings: A Mixed Methods Evaluation of Two Hospital Strategies in the Netherlands.International journal of health policy and management · 2023Article
- A comparison of four quasi-experimental methods: an analysis of the introduction of activity-based funding in Ireland.BMC health services research · 2022Article
- Have Dutch Hospitals Saved Lives and Reduced Costs? A longitudinal patient-level analysis over the years 2013-2017.Health economics · 2021Article
- Analytical methods to assess the impacts of activity-based funding (ABF): a scoping review.Health economics review · 2021Article
- Director's Perceived Competition and Its Relationship with Hospital's Competitive Behaviors: Evidence from County Hospitals in China.Risk management and healthcare policy · 2021Article
- Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands - A Study of 5 Elective Surgeries.International journal of health policy and management · 2020Article
- One-stop routing for surgical interventions: a cost-analysis of endoscopic groin repair.Surgical endoscopy · 2020Article
- Managerial workarounds in three European DRG systems.Journal of health organization and management · 2020Article
- An activity analysis of Dutch hospital-based physician assistants and nurse practitioners.Human resources for health · 2019Article
- Hospital competition and the expenses for treatments of acute and non-acute common diseases: evidence from China.BMC health services research · 2019Article
- Factors influencing current low-value follow-up care after basal cell carcinoma and suggested strategies for de-adoption: a qualitative study.The British journal of dermatology · 2019Article
- Trends and regional variation in rates of orthopaedic surgery in Germany: the impact of competition.The European journal of health economics : HEPAC : health economics in prevention and care · 2019Article
- Why was this transfusion given? Identifying clinical indications for blood transfusion in health care data.Clinical epidemiology · 2018Article
- Article
- Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector.The European journal of health economics : HEPAC : health economics in prevention and care · 2018Article
Corrections and comments
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Authors and funding
3 authors.
Funding
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Abstract
This paper evaluates the impact of market competition on health care volume and cost. At the start of 2005, the financing system of Dutch hospitals started to be gradually changed from a closed-end budgeting system to a non-regulated price competitive prospective reimbursement system. The gradual implementation of price competition is a 'natural experiment' that provides a unique opportunity to analyze the effects of market competition on hospital behavior. We have access to a unique database, which contains hospital discharge data of diagnosis treatment combinations (DBCs) of individual patients, including detailed care activities. Difference-in-difference estimates show that the implementation of market-based competition leads to relatively lower total costs, production volume and number of activities overall. Difference-in-difference estimates on treatment level show that the average costs for outpatient DBCs decreased due to a decrease in the number of activities per DBC. The introduction of market competition led to an increase of average costs of inpatient DBCs. Since both volume and number of activities have not changed significantly, we conclude that the cost increase is likely the result of more expensive activities. A possible explanation for our finding is that hospitals look for possible efficiency improvements in predominantly outpatient care products that are relatively straightforward, using easily analyzable technologies. The effects of competition on average cost and the relative shares of inpatient and outpatient treatments on specialty level are significant but contrary for cardiology and orthopedics, suggesting that specialties react differently to competitive incentives.
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