Perceived Competition and Process of Care in Rural China

Figures & data

Table 1 Patient and Hospital Characteristics

	Competition		Total	P-value
	High	Low
Patients	1176	991	2167
Hospitals	14	10	24
Patient characteristics
Age	23.41 (29.15)	14.81 (25.85)	19.48 (28.01)	<0.001
Hospital characteristics
Whether TCM hospital				<0.001
No	551 (41.34)	782 (58.66)	1333 (61.51)
Yes	625 (74.94)	209 (25.06)	834 (38.49)
Whether tertiary hospital				<0.001
No	1176 (57.03)	886 (42.97)	2062 (95.15)
Yes	0 (0.00)	105 (100.00)	105 (4.85)
Whether first-class hospital				<0.001
No	85 (21.52)	310 (78.48)	395 (18.23)
Yes	1091 (61.57)	681 (38.43)	1772 (81.77)
Beds/100	3.67 (1.93)	3.75 (1.49)	3.71 (1.74)	0.25
Nurses per 100 beds	44.79 (11.07)	44.17 (7.88)	44.51 (9.74)	0.14
Doctors per 100 beds	21.21 (8.05)	21.74 (7.20)	21.45 (7.67)	0.11

Notes: Data are presented as mean (standard deviation) for continuous variables and weighted number (percentage) of row totals for high and low competition groups. Estimated counts were rounded to the nearest unit, and thus, totals across categories may differ from the calculated sums. P-values are calculated using t-test or analysis of variance for continuous variables and the Pearson χ² test or Fisher exact test for categorical variables.

Abbreviation: TCM, Traditional Chinese Medicine.

Table 2 Performance of Individual Process of Care for Patients with Bacterial Pneumonia

Process of Care	High Competition	Low Competition	Total	P-value
	(N=1176)	(N=991)	(N=2167)
Oxygenation assessment				0.48
No	1147 (97.53)	971 (97.98)	2118 (97.74)
Yes	29 (2.47)	20 (2.02)	49 (2.26)
Antibiotic treatment				<0.001
No	37 (3.15)	60 (6.05)	97 (4.48)
Yes	1139 (96.85)	931 (93.95)	2070 (95.52)
First antibiotic treatment within 6 hours				<0.001
No	70 (5.95)	122 (12.31)	192 (8.86)
Yes	1106 (94.05)	869 (87.69)	1975 (91.14)

Notes: Data are presented as weighted number (percentage) of column totals. p-values are calculated using Pearson χ² test or Fisher exact test for categorical variables.

Table 3 The Relationship Between Perceived Competition and Process of Care

	Oxygenation Assessment	Antibiotic Treatment	First Antibiotic Treatment Within 6 hours
Competition
Low (reference)
High	−0.645	1.015*	0.841***
	(0.814)	(0.398)	(0.240)
Age	0.019**	0.025*	0.010
	(0.007)	(0.011)	(0.006)
Whether TCM
No (reference)
Yes	0.906	−5.116***	−2.715***
	(0.983)	(0.814)	(0.639)
Whether tertiary
No (reference)
Yes	0.017	1.024	−0.392
	(1.762)	(1.098)	(0.756)
Whether first-class
No (reference)
Yes	1.752	3.531***	1.834**
	(1.519)	(0.868)	(0.660)
Beds/100	0.824***	−0.662**	−0.330*
	(0.232)	(0.204)	(0.139)
Nurses per 100 beds	−0.030	−0.137***	−0.067***
	(0.041)	(0.028)	(0.019)
Doctors per 100 beds	0.084	−0.055*	−0.023
	(0.050)	(0.024)	(0.021)
Observations	2167	2167	2167
Number of hospitals	24	24	24
C-statistic	0.787	0.886	0.788
Pseudo R-squared	0.110	0.284	0.182

Notes: TCM indicated Traditional Chinese Medicine. Robust standard errors clustered at the hospital in parentheses. *P<0.05, **P<0.01, ***P<0.001.

Table 4 The Interaction Relationship Between Perceived Competition and Competition Source

	Oxygenation Assessment	Antibiotic Treatment	First Antibiotic Treatment Within 6 hours
Competition
Low (reference)
High	−0.447	0.889	0.653**
	(1.257)	(0.473)	(0.237)
High competition # Out-of-county	−0.521	0.606	0.708
	(1.767)	(0.408)	(0.516)
Competition source
Within-county (reference)
Out-of-county	0.146	0.037	0.041
	(0.880)	(0.258)	(0.225)
Other control variables	Yes	Yes	Yes
Observations	2045	2045	2045
C-statistic	0.788	0.881	0.797
Pseudo R-squared	0.120	0.279	0.186

Notes: All models above adjusted for patient and hospital characteristics, including age, whether traditional Chinese medicine hospital, whether tertiary hospital, whether first-class hospital, bed size, number of nurses per 100 beds, and number of doctors per 100 beds. The estimated coefficients of the other control variables are available from the authors on request. Robust standard errors clustered at the hospital in parentheses. **P<0.01.

Table 5 Robustness Checks

	Oxygenation Assessment	Antibiotic Treatment	First Antibiotic Treatment Within 6 hours
a) Excluding patients admitted to hospitals perceiving no competition pressure
Competition
Low (reference)
High	−0.696	1.137**	0.975***
	(0.842)	(0.429)	(0.252)
Other control variables	Yes	Yes	Yes
Observations	2074	2074	2074
C-statistic	0.781	0.883	0.792
Pseudo R-squared	0.110	0.279	0.184
b) Excluding patients admitted to tertiary hospitals
Competition
Low (reference)
High	−0.644	1.089**	0.901***
	(0.815)	(0.399)	(0.242)
Other control variables	Yes	Yes	Yes
Observations	2062	2062	2062
C-statistic	0.787	0.856	0.730
Pseudo R-squared	0.109	0.202	0.086
c) Clustered standard errors at the county level
Competition
Low (reference)
High	−0.645	1.015*	0.841**
	(0.815)	(0.434)	(0.304)
Other control variables	Yes	Yes	Yes
Observations	2167	2167	2167
C-statistic	0.787	0.886	0.788
Pseudo R-squared	0.110	0.284	0.182

Notes: All models above adjusted for patient and hospital characteristics, including age, whether Traditional Chinese Medicine hospital, whether tertiary hospital, whether first-class hospital, bed size, number of nurses per 100 beds, and number of doctors per 100 beds. We report the estimated competition coefficients for clarity. The estimated coefficients of the control variables are available from the authors on request. Unless otherwise indicated, robust standard errors clustered at the hospital in parentheses. *P<0.05, **P<0.01, ***P<0.001.