Hospital competition, managed care, and mortality after hospitalization for medical conditions: Evidence from three states

José J. Escarce, Arvind K. Jain, Jeannette Rogowski

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

This study assessed the effect of hospital competition and HMO penetration on mortality after hospitalization for six medical conditions in California, New York, and Wisconsin. We used linked hospital-discharge and vital-statistics data to study adults hospitalized for myocardial infarction, hip fracture, stroke, gastrointestinal hemorrhage, congestive heart failure, or diabetes. We estimated logistic regression models with death within 30 days of admission as the dependent variable and hospital competition, HMO penetration, and hospital and patient characteristics as explanatory variables. Higher hospital competition was associated with lower mortality in California and New York but not Wisconsin. Higher HMO penetration was associated with lower mortality in California but higher mortality in New York. These findings suggest that hospitals in highly competitive markets compete on quality even in the absence of mature managed-care markets. The findings also underscore the need to consider geographic effects in studies of market structure and hospital quality.

Original languageEnglish (US)
Pages (from-to)112S-140S
JournalMedical Care Research and Review
Volume63
Issue number6
DOIs
StatePublished - Dec 2006

All Science Journal Classification (ASJC) codes

  • Health Policy

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