Hospital Competition and Patient Safety

Background:  The hospital market in California has undergone several changes including mergers and acquisitions and the emergence of managed care. Hospital competition has been studied extensively in this area. The current literature has been unable to determine the extent of the effect that hospital competition has on patient safety.

Objective: This project attempts to determine the relationship between patient safety and hospital competition, using the process of care measures reported to the Hospital Compare database, and the competition measure HHI calculated for health service areas in California.

Methods: The relationship between the hospital competition measure and the 26 patient safety measures was assessed utilizing a regression analysis. The dependent variables are the patient safety measures, the key independent variable is the hospital competition measure HHI. To account for hospital characteristics, bed size and ownership status were used as controls. To account for market characteristics, per capita income, unemployment rate, and population were used as controls. A total of 624 regressions were conducted for 11 separate diagnostic related groups and for the total patient discharges in the state of California. 

Results: Results indicate hospital competition does not have a large effect on patient safety. The effect is multidirectional; however the majority of measures shows an insignificant relationship with hospital competition. Utilizing HHI to measure hospital competition appears to warrant further research.

Conclusions: Hospital competition is not strongly correlated with the patient safety measures in the hospital compare database. Future research should focus on other factors that may affect patient safety at the hospital level.