ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2023
Does competition improve hospital performance: a DEA based evaluation from the Netherlands.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Approach in inputs & outputs selection of Data Envelopment Analysis (DEA) efficiency measurement in hospitals: A systematic review.PloS one · 2024Pooled it
- Evaluating Hospital Efficiency and Productivity: A Bootstrap-Corrected DEA and Malmquist Analysis.Healthcare (Basel, Switzerland) · 2026Article
- Fragmentation in health system financing: a major challenge for improving effectiveness, efficiency, equity and choice within health systems.BMJ public health · 2026Review
- Operational intelligence for immunization recovery: mapping system shocks and capacity to zero-dose debt and outbreak risk.Frontiers in health services · 2026Article
- Hospital efficiency assessment: a systematic review of DEA and hybrid DEA-machine learning approaches.Frontiers in medical technology · 2026Review
- Measuring productivity in the healthcare sector: a bibliometric and content analysis.Health economics review · 2025Article
- Effects of Hospital Payment Reform of Government Budget Allocation and Social Health Insurance in a Pilot in China.International journal of health policy and management · 2025Article
- Active Purchasing: Empirical Insights From the Dutch Healthcare System and Lessons for Low- and Middle-Income Countries Comment on "Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands".International journal of health policy and management · 2025Article
- The Knowledge and Application of Economics in Healthcare in a High-Income Country Today: The Case of Belgium.Journal of market access & health policy · 2024Article
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Authors and funding
5 authors.
Funding
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Abstract
Many countries have introduced competition among hospitals aiming to improve their performance. We evaluate the introduction of competition among hospitals in the Netherlands over the years 2008-2015. The analysis is based on a unique longitudinal data set covering all Dutch hospitals and health insurers, as well as demographic and geographic data. We measure hospital performance using Data Envelopment Analysis and distinguish three components of competition: the fraction of freely negotiated services, market power of hospitals, and insurer bargaining power. We present new methods to define variables for each of these components which are more accurate than previously developed measures. In a multivariate regression analysis, the variables explain more than half of the variance in hospital efficiency. The results indicate that competition between hospitals and the relative fraction of freely negotiable health services are positively related to hospital efficiency. At the same time, the policy measure to steadily increase the fraction of health services contracted in competition may well have resulted in a decrease in hospital efficiency. The models show no significant association between insurer bargaining power and hospital efficiency. Altogether, the results offer little evidence that the introduction of competition for hospital care in the Netherlands has been effective.
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