Premium
Market Competition and Health Outcomes in Hemodialysis
Author(s) -
Erickson Kevin F.,
Zheng Yuanchao,
Ho Vivian,
Winkelmayer Wolfgang C.,
Bhattacharya Jay,
Chertow Glenn M.
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12835
Subject(s) - medicine , hemodialysis , dialysis , monopoly , competition (biology) , population , demography , environmental health , economics , ecology , market economy , biology , sociology
Objective To examine whether market competition is associated with improved health outcomes in hemodialysis. Data Sources Secondary analysis of data from a national dialysis registry between 2001 and 2011. Study Design We conducted one‐ and two‐part linear regression models, using each hospital service area ( HSA ) as its own control, to examine the independent associations among market concentration and health outcomes. Data Collection We selected cohorts of patients receiving in‐center hemodialysis in the United States at the start of each calendar year. We used information about dialysis facility ownership and the location where patients received dialysis to measure an index of market concentration—the Hirschman‐Herfindahl Index ( HHI )—for HSA and year, which ranges from near zero (perfect competition) to one (monopoly). Principal Findings An average reduction in HHI by 0.2 (one standard deviation in 2011) was associated with 2.9 fewer hospitalizations per 100 patient‐years (95 percent CI , 0.4 to 5.4). If these findings were generalized to the entire in‐center hemodialysis population, this would translate to 8,100 (95 percent CI 1,200 to 15,000) fewer hospitalizations in 2011. There was no association between change in market competition and mortality. Conclusions Market competition in dialysis may lead to improved health outcomes.