TY  - JOUR
AU  - Escarce,José J.
AU  - Jain,Arvind K.
AU  - Rogowski,Jeannette
TI  - Hospital Competition, Managed Care and Mortality After Hospitalization for Medical Conditions: Evidence From Three States
JF  - National Bureau of Economic Research Working Paper Series
VL  - No. 12335
PY  - 2006
Y2  - June 2006
UR  - http://www.nber.org/papers/w12335
L1  - http://www.nber.org/papers/w12335.pdf
N1  - Author contact info:
Jose Escarce
UCLA Med-GIM-HSR
911 Broxton Avenue
Box 951736
Los Angeles, CA  90024
Tel: 310/794-3842
Fax: 310/794-0732
E-Mail: jescarce@mednet.ucla.edu

Jeannette A. Rogowski
UMDNJ - School of Public Health
Department of Health Systems and Policy
683 Hoes Lane West, Room 332
Piscataway, NJ  08854
Tel: 732/235-9759
Fax: 732/235-4004
E-Mail: rogowsje@umdnj.edu
M2  - featured in NBER digest on 2006-06-26
AB  - This study assessed the effect of hospital competition and HMO penetration on mortality after hospitalization for six medical conditions in California, New York, and Wisconsin. We used linked hospital discharge and vital statistics data to study adults hospitalized for myocardial infarction, hip fracture, stroke, gastrointestinal hemorrhage, congestive heart failure, or diabetes. We estimated logistic regression models with death within 30 days of admission as the dependent variable and hospital competition, HMO penetration, and hospital and patient characteristics as explanatory variables. Higher hospital competition was associated with lower mortality in California and New York, but not Wisconsin. In addition, higher HMO penetration was associated with lower mortality in California, but higher mortality in New York. In the context of the study states%u2019 history with managed care, these findings suggest that hospitals in highly competitive markets compete on quality even in the absence of mature managed care markets. The findings also underscore the need to consider geographic effects in studies of market structure and hospital quality.
ER  -