The Effect of Ownership and Competition on Hospital Outcomes before and after the National Health Insurance
Date Issued
2011
Date
2011
Author(s)
Tai, Wan-Ying
Abstract
This paper reexamines the effect of hospital ownership and competition on hospital outcomes before and after the National Health Insurance (NHI) using the labor insurance inpatient data. The results of IV estimation indicate that non-profit hospitals yield better long-term quality in medical care, yet there are differences in the effect on the outcomes among several public hospital systems when using more detailed ownership data. Furthermore, the results of Chow Test show that the effect of hospital ownership has a structural break after the NHI, which implies more cost and better treatment quality in private hospitals and higher long-term mortality in non-profit hospitals. On the other hand, the decrease in hospital competition after the NHI enhances the treatment expenditure and has no significant effect on the mortality, which is inconsistent with the Medical Arm Race (MAR) hypothesis. However, we find that the larger scale of hospitals does yield less treatment expenditure and mortality after the NHI, implying that the competition may reflect on the scale of hospitals instead of the market concentration.
Subjects
National Health Insurance
Hospital Ownership
Hospital Competition
Hospital Outcome
Mortality
Treatment Expenditure
Type
thesis
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