The Role of Hospital Competition on Treatment Expenditure and Qutcome of Care: Evidence from Stroke and Cardiac Treatment in Taiwan

Abstract

This article examines whether market competition affects treatment expenditure and health outcomes of stroke and cardiac treatment in Taiwan. Our measure of treatment expenditure is the hospital expenditure paid at the index admission (short term) and the sum of inpatient and outpatient expenditures paid in the subsequent year (long term). Our measure of health outcome is the probability of death in 1 and 12 months after the hospital`s discharge. Our measure of competition follows the method developed by Kessler and McClellan that calculates the Herfindal index based on the predicted patient flows using exogenous variables (e.g., traveling distance to hospitals). Using data of patients hospitalized for new stroke and cardiac treatment between 1997 and 2001 in Taiwan, we find that an increase of market competition results in an insignificant impact on a patient`s mortality. In terms of treatment expenditure, our results indicate that hospitals facing more competition incur higher expenditures, either the short- or long-term expenditure. Finally, we find evidence showing that an increase of treatment expenditure at admission is due to a raise of length of stay and treatment intensity per day as well as the usage of expensive equipment.