The Impact of Hospital Competition on Strategies and Outcomes of Hospitals: A Systematic Review of the U.S. Hospitals 1996-2016

Abstract

Purpose: This study aims to review the literature about the impact of hospital competition on strategies and outcomes of hospitals 1996-2016.

Design/methodology/approach: Four well-established databases including PubMed, Scopus, Google Scholar and Embase were chosen to perform a comprehensive search by using keywords related to completion, hospital, and various measures of competition. The search generated 9,806 articles. After removing the duplicates and eliminating the non-relevant publications by utilizing pre-determined criteria, 65 articles remained for abstraction.

Findings: The results indicated that majority of studies (about 88%) used Herfindahl-Hirschman Index (HHI) to measure hospital competition, whereas the remaining 12% used the number of competitors in the market. Forty studies (61%) defined hospital market based on Metropolitan Services Area, County, Health Services Area, Health Referral Region (HRR), Hospital Services Area, and Health Facility Planning Area, whereas the reminder used some other definitions such as Euclidian distance, radius, or patient-flow. Finally, concerning statistical relationships, out of 143 explored relationships, almost half of them found significant relationship between hospital competition and various outcome measures (35 positive and 38 negative), whereas the remaining 70 (or 49%) did not find any significant association.

Originality/value: This is the most current and comprehensive systematic review summarizing the result of different studies of hospital competition and its effect on specific hospital outcomes or strategies.