ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1543884
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 53 articles
The impact of hospital competition on healthcare quality: Evidence from China's healthcare reform
Provisionally accepted
- 1Jiangxi University of Science and Technology, Ganzhou, China
- 2Shandong University, Jinan, Shandong Province, China
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Introduction: Hospital competition has been a common feature in healthcare reforms worldwide, yet scant attention has been paid to its impact on healthcare quality in China. This study aims to comprehensively evaluate the impact of hospital competition on healthcare quality under China’s healthcare reform.Methods: This study used multiple datasets comprising city-level and individual-level data of 21,974 individuals across 150 districts. We employed a two-way fixed effects model to estimate the impact of hospital competition on healthcare quality. To mitigate endogeneity concerns, we instrumented hospital competition with the inverse of the average distance and average travel time from patients to hospitals and performed the Two-Stage Least Squares methods. Results: This study showed a positive effect of hospital competition on both technical and non-technical healthcare quality. The impact is larger for primary hospitals and inpatient services; it is significantly positive for technical healthcare quality in public hospitals. Additionally, our findings implied that hospital competition affects healthcare income, which in turn affects non-technical healthcare quality, but healthcare income and demand jointly influence the relationship between hospital competition and technical healthcare quality. Conclusion: The finding provides new evidence of the impact of hospital competition on both technical and non-technical healthcare quality in China, highlighting a positive relationship that differs from some previous studies. This evidence offers valuable policy implications on hospital competition and also emphasizes the importance of considering the heterogeneity of hospitals and services in policy-making.
Keywords: Hospital, competition, technical healthcare quality, non-technical healthcare quality, Healthcare reform in China, Sustainable Development Goals (SDGs), SDG 3, Good health and well-being
Received: 12 Dec 2024; Accepted: 15 May 2025.
Copyright: © 2025 Liu, Jiang, Yu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Junyan Jiang, Shandong University, Jinan, 250100, Shandong Province, China
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