Fachvortrag: Multilevel Analyses of Cancer Surgery in France

Impact of competition versus centralisation of care on hospital treatment quality

Lecture by Zeynep Or

The implications of competition in health, particularly among hospitals, on care quality have been the subject of considerable theoretical and empirical debate. On one hand, economic theory suggests that when prices are regulated, firms compete for consumers on non-price dimensions (i.e. quality), hence quality will be increased in competitive markets. On the other hand, hospital consolidations have been justified by the need to exploit cost advantages (economies of scale) acquired through mergers, and by quality concerns recognising that hospital volume and care quality are related. Hence hospital markets are increasingly concentrated.

Based on a study of patient-level data from two years, 2005 and 2012, in order to track changes in market competition and treatment patterns in breast cancer surgery the presentation will question whether, and to what extent, concentration in French hospital markets for cancer care has affected clinical practices and treatment quality. It will introduce the issues around measuring the link between competition and quality and present a novel way of examining quality and competition.

Globally, the results suggest that local market competition may be a trigger for hospitals to invest in novel and better quality treatments. Yet, hospital volume remains a significant indicator of quality, therefore benefits of competition versus centralisation appear to be sensitive to the estimates of the impact of volume on outcomes. Furthermore, the findings show that different hospital types have different practice styles and that centralisation of activity have contributed to improving cancer treatment in France.

Please register per Mail: athea(at)athea.at.

The event is organised by the Austrian Health Economics Association (ATHEA) in cooperation with IHS.