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Hospital Competition, Managed Care and Mortality After Hospitalization for Medical Conditions: Evidence From Three States


Jeannette Rogowski


Jeannette Rogowski, Jose Escarce, Arvind Jain

Chair: Ryan Mutter; Discussant: Lan Liang Mon June 5, 2006 17:15-18:45 Room 213

Objective: 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.

Data: Linked hospital discharge and vital statistics data were used to study adults hospitalized for myocardial infarction, hip fracture, stroke, gastrointestinal hemorrhage, congestive heart failure or diabetes. Methods: Logistic regression models were estimated with death within 30 days of admission as the dependent variable and hospital competition, HMO penetration, and hospital and patient characteristics as explanatory variables. Standard errors were corrected for clustering of admissions within hospitals using a Huber-White sandwich estimator.

Results: 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. Conclusion: In the context of the study states’ history with managed care, 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.


3rd Biennial Conference: Cornell on June 20-23 2010

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