The Impact of Competition on Management Quality: Evidence from Public Hospitals
The Impact of Competition on Management Quality: Evidence from Public Hospitals
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DOI：
10.1093/restud/rdu045
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发表时间：
2015-04-01
影响因子：
5.8
通讯作者：
Van Reenen, John
中科院分区：
文献类型：
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作者：
Bloom, Nicholas;Propper, Carol;Van Reenen, John
我们分析了竞争对管理质量和医院绩效的因果影响。为了解决市场结构的内生性问题，我们分析了英国公立医院部门的进入和退出由中央政府控制。由于担心选举失败，执政党很少关闭选举竞争激烈的地区（“边缘”）的医院，因此我们可以将政治边缘性作为地理区域内医院数量的工具变量。我们发现，更高的竞争导致更高的管理质量，使用一种新的调查工具来衡量，并改善了医院的绩效。增加一家竞争医院将使管理质量提高0.4个标准差，并使急诊心脏病发作的存活率提高9.7%。我们确认，我们的静脉注射战略对于可以在边缘地区用于改善医院管理的“隐性政策”以及可能因医院关闭而导致的能力变化具有稳健性。
We analyse the causal impact of competition on managerial quality and hospital performance. To address the endogeneity of market structure we analyse the English public hospital sector where entry and exit are controlled by the central government. Because closing hospitals in areas where the governing party is expecting a tight election race ("marginals") is rare due to the fear of electoral defeat, we can use political marginality as an instrumental variable for the number of hospitals in a geographical area. We find that higher competition results in higher management quality, measured using a new survey tool, and improved hospital performance. Adding a rival hospital increases management quality by 0.4 standard deviations and increases survival rates from emergency heart attacks by 9.7%. We confirm the robustness of our IV strategy to "hidden policies" that could be used in marginal districts to improve hospital management and to changes in capacity that may follow from hospital closure.