title: The association of market competition with hospital charges, length of stay, and quality outcomes for patients with joint diseases: a longitudinal study in Korea.
abstract: This study investigated the association of market competition with hospital charges, length of stay, and quality outcomes. A total of 279,847 patients from 851 hospitals were analyzed. The Herfindahl-Hirschman Index was used as a measure of hospital market competition level. Our results suggest that hospitals in less competitive markets charged more on charge per admission, possibly by increasing the length of stays, however, hospitals in more competitive markets charged more for daily services by providing more intensive services while reducing the length of stays, thereby reducing the overall charge per admission. Quality outcomes measured by mortality within 30 days of admission and readmission within 30 days of discharge were better for surgical procedures within competitive areas. Continued government monitoring of hospital response to market competition level is recommended in order to determine whether changes in hospitals' strategies influence the long-term outcomes of services performance and health care spending.
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, South Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sun Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun-Cheol
authors.initials: EC
authors.lastname: Park
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, South Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Ki-Bong
authors.initials: KB
authors.lastname: Yoo
authors.affiliation: Department of Public Health, Yonsei University College of Medicine, Seoul, South Korea Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jeoung A
authors.initials: JA
authors.lastname: Kwon
authors.affiliation: Institute of Health Services Research, Yonsei University College of Medicine, Seoul, South Korea Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, South Korea thkim@yuhs.ac.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
mesh_terms: D004465:Economic Competition / Q000706:statistics & numerical data*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007592:Joint Diseases / Q000191:economics*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D056910:Republic of Korea; D016896:Treatment Outcome
keywords: Herfindahl-Hirschman Index; Korea; hospital; inpatient discharge; length of stay; market competition; mortality; readmission