Association between market concentration of hospitals and patient health gain following hip replacement surgery

Feng, Yan; Pistollato, Michele; Charlesworth, Anita; Devlin, Nancy; Propper, Carol; Sussex, Jon

doi:10.1177/1355819614546032

Cited by 21 publications

(20 citation statements)

References 13 publications

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“… 58 Studies across other specialties have shown mixed results for the effect of fixed-price markets on improvements in health-care quality. 8 , 23 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 …”

Section: Discussionmentioning

confidence: 99%

Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study

Aggarwal

Lewis

Mason

et al. 2017

The Lancet Oncology

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SummaryBackgroundThere is a scarcity of evidence about the role of patient choice and hospital competition policies on surgical cancer services. Previous evidence has shown that patients are prepared to bypass their nearest cancer centre to receive surgery at more distant centres that better meet their needs. In this national, population-based study we investigated the effect of patient mobility and hospital competition on service configuration and technology adoption in the National Health Service (NHS) in England, using prostate cancer surgery as a model.MethodsWe mapped all patients in England who underwent radical prostatectomy between Jan 1, 2010, and Dec 31, 2014, according to place of residence and treatment location. For each radical prostatectomy centre we analysed the effect of hospital competition (measured by use of a spatial competition index [SCI], with a score of 0 indicating weakest competition and 1 indicating strongest competition) and the effect of being an established robotic radical prostatectomy centre at the start of 2010 on net gains or losses of patients (difference between number of patients treated in a centre and number expected based on their residence), and the likelihood of closing their radical prostatectomy service.FindingsBetween Jan 1, 2010, and Dec 31, 2014, 19 256 patients underwent radical prostatectomy at an NHS provider in England. Of the 65 radical prostatectomy centres open at the start of the study period, 23 (35%) had a statistically significant net gain of patients during 2010–14. Ten (40%) of these 23 were established robotic centres. 37 (57%) of the 65 centres had a significant net loss of patients, of which two (5%) were established robotic centres and ten (27%) closed their radical prostatectomy service during the study period. Radical prostatectomy centres that closed were more likely to be located in areas with stronger competition (highest SCI quartile [0·87–0·92]; p=0·0081) than in areas with weaker competition. No robotic surgery centre closed irrespective of the size of net losses of patients. The number of centres performing robotic surgery increased from 12 (18%) of the 65 centres at the beginning of 2010 to 39 (71%) of 55 centres open at the end of 2014.InterpretationCompetitive factors, in addition to policies advocating centralisation and the requirement to do minimum numbers of surgical procedures, have contributed to large-scale investment in equipment for robotic surgery without evidence of superior outcomes and contributed to the closure of cancer surgery units. If quality performance and outcome indicators are not available to guide patient choice, these policies could threaten health services' ability to deliver equitable and affordable cancer care.FundingNational Institute for Health Research.

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“… 58 Studies across other specialties have shown mixed results for the effect of fixed-price markets on improvements in health-care quality. 8 , 23 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 …”

Section: Discussionmentioning

confidence: 99%

Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study

Aggarwal

Lewis

Mason

et al. 2017

The Lancet Oncology

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“…The experience of the UK has suggested that, in a quasi-market, increased competition can, under certain circumstances, lead to increased quality without increasing costs (Gaynor et al, 2010). However, this proposition does not seem to hold generally (Feng et al, 2014;Gravelle et al, 2012). Somewhat similarly, private competitive markets in the US seem to reduce costs without sacrificing quality.…”

Section: 4mentioning

confidence: 97%

The core of the Nordic health care system is not empty

Lyttkens

Christiansen

Häkkinen³

et al. 2016

Nordic J Health Eco

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The Nordic countries are well-known for their welfare states. A very important feature of the welfare state is that it aims at easy and equal access to adequate health care for the entire population. For many years, the Nordic systems were automatically viewed as very similar, and they were placed in the same group when the OECD classified health care systems around the world. However, close inspection soon reveals that there are important differences between the health care systems of Denmark, Finland, Iceland, Norway and Sweden. Consequently, it is perhaps no surprise that the Nordic countries fell into three different categories when the OECD revised its classification a few years ago. In this paper, we revisit this issue and argue that the most important similarity across the Nordic countries is the institutional context in which the health care sector is embedded. Nordic health care exists in a high-trust, high-taxation setting of small open economies. With this background, we find a set of important similarities in the manner in which health care is organized and financed in the Nordic countries. To evaluate the performance of the Nordic health care system, we compare a few health quality indicators in the Nordic countries with those of five non-Nordic similarly small open European economies with the same level of income. Overall, the Nordic countries seem to be performing relatively well. Whether they will continue to do so will depend to a large extent on whether the welfare state will continue to reform itself as it has in the past.Published: April 2016.

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“…Kansainvälisessä kirjallisuudessa sähköisten potilaskertomusten tietojärjestelmien keskittyneisyyttä ja sen voimakkuutta on kuvattu Herfindahl-Hirschmanindeksillä (HHI) [29] muiden muassa Yhdysvalloissa [30], Iso-Britanniassa [31] ja Koreassa [32].…”

Section: 32019unclassified

Terveyskeskusten ja erikoissairaanhoidon sairaaloiden sähköisten potilaskertomusten markkinat olivat erittäin keskittyneet vuonna 2017 – onko syytä olla huolissaan?

Jormanainen¹,

Parhiala²,

Reponen³

2019

FinJeHeW

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Potilas- ja asiakastiedon käsittelyyn tarkoitetut ohjelmistot ovat kaupallisia sovelluksia, joiden tuotemerkit eroavat toisistaan esimerkiksi käytettävyyden perusteella. Aiemmat terveydenhuollon potilastiedon ja sosiaalihuollon asiakastiedon sähköisten tietojärjestelmien kertomusosioiden tuotemerkkien selvitykset ovat perustuneet kyselytutkimusten henkilö- tai organisaatiovastaajien otoksiin sekä erillisiin kyselyihin tai tietopyyntöihin. Selvitimme osana virkatyötä terveyskeskuksissa ja sairaanhoitopiirien sairaaloissa käytettyjen sähköisten potilaskertomusten markkinaosuudet vuonna 2017 sairaanhoitopiireittäin ja erityisvastuualueittain kaikissa kunnissa ja järjestämisen kuntayhtymissä. Vuonna 2017 terveyskeskuksissa oli käytössä kuusi potilaskertomusten tuotemerkkiä, kun luku oli yhdeksän vuonna 2002. Väestöjen perusteella markkinaosuus oli suurin Efficalla (43 %) ja Pegasoksella (36 %), kun se oli 7 % Lifecarella, 6 % Mediatrilla, 5 % Graafisella Finstarilla ja 1 % Abilitalla. Terveyskeskusten potilaskertomusten kuudella tuotemerkillä oli neljä valmistajaa. Sairaanhoitopiirin alueen terveyskeskukset käyttivät 1–5 potilaskertomusta. Yhtä potilaskertomusta käyttivät yhdeksän sairaanhoitopiirin alueen terveyskeskukset. Sairaaloissa oli käytössä viisi eri sähköistä potilaskertomusta (Abilita, Effica, ESKO, Mediatri ja Uranus) vuonna 2017, kun luku oli seitsemän vuonna 2001. Sairaanhoitopiirien potilaskertomusten viidellä tuotemerkillä oli viisi valmistajaa. Sama tuotemerkki oli käytössä yhdeksän sairaanhoitopiirin alueen terveyskeskuksissa ja sairaaloissa. Erityisvastuualueilla oli käytössä alueen terveyskeskuksissa 4–5 ja erikoissairaanhoidossa 2–4 eri potilaskertomusta. Sähköisten potilaskertomusten markkinat olivat erittäin keskittyneet (HHI=3300) vuonna 2017.

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Association between market concentration of hospitals and patient health gain following hip replacement surgery

Cited by 21 publications

References 13 publications

Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study

Effect of patient choice and hospital competition on service configuration and technology adoption within cancer surgery: a national, population-based study

The core of the Nordic health care system is not empty

Terveyskeskusten ja erikoissairaanhoidon sairaaloiden sähköisten potilaskertomusten markkinat olivat erittäin keskittyneet vuonna 2017 – onko syytä olla huolissaan?

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