Perceived Competition and Process of Care in Rural China

Abstract

Purpose

Although there is much debate about the effect of hospital competition on healthcare quality, its impact on the process of care remains unclear. This study aimed to determine whether hospital competition improves the process of care in rural China.

Patients and Methods

The county hospital questionnaire survey data and the randomly sampled medical records of bacterial pneumonia patients in 2015 in rural area of Guizhou, China, were used in this study. The processes of care for bacterial pneumonia were measured by the following three measures: 1) oxygenation assessment, 2) antibiotic treatment, and 3) first antibiotic treatment within 6 hours after admission. Hospital competition was measured by asking hospital directors to rate the competition pressure they perceive from other hospitals. Multivariate logistic regression models were employed to determine the relationship between perceived competition and the processes of care for patients with bacterial pneumonia.

Results

A total of 2167 bacterial pneumonia patients from 24 county hospitals in 2015 were included in our study. Our results suggested that the likelihood of receiving antibiotic treatment and first antibiotic treatment within 6 hours after admission was significantly higher in the hospitals perceiving higher competition pressure. However, no significant relationship was found between perceived competition and oxygenation assessment for patients with bacterial pneumonia.

Conclusion

This study revealed the role of perceived competition in improving the process of care under the fee-for-service payment system and provided empirical evidence to support the pro-competition policies in China’s new round of national healthcare reform.

Keywords:

• perceived competition
• market concentration
• process of care
• pneumonia
• quality
• healthcare reform

Acknowledgments

We thank Wen Chen, Min Hu, and Luying Zhang in Fudan University for their great contribution to the preparation of the Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH) project. We are also grateful to two anonymous referees and an anonymous editor for highly valuable comments.

Ethics and Consent Statement

The Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH) project was led by Harvard University, and the project partners included Fudan University, Sichuan University, Peking University, and Sun Yat-sen University. The preparation work before implementing the project was conducted and finished by Fudan University, therefore this project was reviewed and approved by the School of Public Health Institutional Review Board, Fudan University (Approval number: IRB#2015-08-0561). This project was conducted in accordance with the Declaration of Helsinki. The patient consent to review their medical records was not required by the Institutional Review Board because the medical records we extract from hospitals were de-identified and the use of data cannot result in any damage or distress. Prior to the formal survey, we informed the hospital directors and obtained their oral and written informed consent to take part in our survey.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (Grant No. 71874116), Ministry of Education of China (Grant No. 18YJA790062), Chengdu Federation of Social Science Association (Grant No. ZZ05), Sichuan University (Grant No. 2018hhf-27 and SKSYL201811), and China Medical Board (Grant No. 17-276).