ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2019
Trends and regional variation in rates of orthopaedic surgery in Germany: the impact of competition.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Regional Variation in Wrist Ligament Surgery Incidence: A 25-year Nationwide Register Study.Plastic and reconstructive surgery. Global open · 2026Article
- [The Effect of Service Concentration on Outcome Quality in Obstetrics Departments - An Empirical Analysis of Newborn Mortality in German Hospitals].Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2025Article
- Association between Regional Market Competition and Early Femoropopliteal Interventions for Claudication.Annals of vascular surgery · 2025Article
- Article
- Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes.Global spine journal · 2022Review
- Adoption of large-scale medical equipment: the impact of competition in the German inpatient sector.The European journal of health economics : HEPAC : health economics in prevention and care · 2022Article
- Comparing the dangers of a stay in English and German hospitals for high-need patients.Health services research · 2021Article
- An individualized decision aid for physicians and patients for total knee replacement in osteoarthritis (Value-based TKR study): study protocol for a multi-center, stepped wedge, cluster randomized controlled trial.BMC musculoskeletal disorders · 2021Article
- Trends in rates of orthopedic surgery in Germany: the good, the bad, and the ugly.The European journal of health economics : HEPAC : health economics in prevention and care · 2020Article
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3 authors.
Funding
Abstract
Competition in hospital services has been fostered in an increasing number of OECD countries with the goal that hospitals improve quality and/or efficiency. With the same intention competition has been promoted in Germany when introducing a system of prospective payments based on diagnosis-related groups (DRGs) in 2003. Beyond its intended effects, however, the reform led to a substantial increase in hospital activity, particularly for orthopaedic surgery. To shed more light on these developments, this paper analyses the relationship between the rates of certain orthopaedic surgical procedures and hospital competition across and within each of Germany's 402 districts. We measured competition with the Herfindahl-Hirschman Index (HHI) based on market shares for hip replacements, knee replacements and spine surgeries. Using spatial panel regression, which allows for spatial dependency and unobserved individual heterogeneity, we found that the rate of hip and knee replacements rose as market concentration increased. A potential explanation might be that hospitals specialize in these particular procedures.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.