{"title":"Is local competition effective in improving quality and efficiency of hospitals? Insights from an asymmetric spatial competition model","authors":"Calogero Guccio , Domenico Lisi , Marco Ferdinando Martorana , Giacomo Pignataro","doi":"10.1016/j.rie.2024.100962","DOIUrl":null,"url":null,"abstract":"<div><p>A critical aspect of healthcare reforms in various countries revolves around the relationship between efficiency, quality, and competition. Exploring the spatial dimension of competition is essential to understand this connection thoroughly. In this study, we develop a theoretical model that examines hospitals' choices regarding quality and cost-containment efforts across different competitive environments characterized by varying spatial distributions of hospitals. We derive and fully characterize hospitals' reaction functions and Nash equilibria concerning quality and cost-containment efforts. Our findings reveal that while localized competition tends to reduce hospitals' efforts in cost containment, its impact on treatment quality can vary. This variation depends on factors such as the cost of delivering quality care, its benefits to patients, and hospitals' objectives, including their level of altruism. Our findings contribute to the ongoing debate on the role of local competition in healthcare. They offer insights into the conditions that could yield divergent outcomes, often advocated by conflicting perspectives. These conditions serve as a foundation for refining competition policy models in healthcare.</p></div>","PeriodicalId":46094,"journal":{"name":"Research in Economics","volume":"78 3","pages":"Article 100962"},"PeriodicalIF":1.2000,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1090944324000267/pdfft?md5=1d28f5b3a17b1d0dbec1d755118bcce4&pid=1-s2.0-S1090944324000267-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research in Economics","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1090944324000267","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ECONOMICS","Score":null,"Total":0}
引用次数: 0
Abstract
A critical aspect of healthcare reforms in various countries revolves around the relationship between efficiency, quality, and competition. Exploring the spatial dimension of competition is essential to understand this connection thoroughly. In this study, we develop a theoretical model that examines hospitals' choices regarding quality and cost-containment efforts across different competitive environments characterized by varying spatial distributions of hospitals. We derive and fully characterize hospitals' reaction functions and Nash equilibria concerning quality and cost-containment efforts. Our findings reveal that while localized competition tends to reduce hospitals' efforts in cost containment, its impact on treatment quality can vary. This variation depends on factors such as the cost of delivering quality care, its benefits to patients, and hospitals' objectives, including their level of altruism. Our findings contribute to the ongoing debate on the role of local competition in healthcare. They offer insights into the conditions that could yield divergent outcomes, often advocated by conflicting perspectives. These conditions serve as a foundation for refining competition policy models in healthcare.
期刊介绍：
Established in 1947, Research in Economics is one of the oldest general-interest economics journals in the world and the main one among those based in Italy. The purpose of the journal is to select original theoretical and empirical articles that will have high impact on the debate in the social sciences; since 1947, it has published important research contributions on a wide range of topics. A summary of our editorial policy is this: the editors make a preliminary assessment of whether the results of a paper, if correct, are worth publishing. If so one of the associate editors reviews the paper: from the reviewer we expect to learn if the paper is understandable and coherent and - within reasonable bounds - the results are correct. We believe that long lags in publication and multiple demands for revision simply slow scientific progress. Our goal is to provide you a definitive answer within one month of submission. We give the editors one week to judge the overall contribution and if acceptable send your paper to an associate editor. We expect the associate editor to provide a more detailed evaluation within three weeks so that the editors can make a final decision before the month expires. In the (rare) case of a revision we allow four months and in the case of conditional acceptance we allow two months to submit the final version. In both cases we expect a cover letter explaining how you met the requirements. For conditional acceptance the editors will verify that the requirements were met. In the case of revision the original associate editor will do so. If the revision cannot be at least conditionally accepted it is rejected: there is no second revision.
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