The Effect of Competition on Process and Outcome Quality within Hospital Care in the Netherlands

This study examines the impact of competition on hospital quality. Our panel covers all Dutch hospitals in the period 2004–2008, in which the transparency of hospital quality information increased substantially. The paper contributes to the existing literature by including both outcome and process indicators of quality. We find that competition explains the cross-sectional differences in process indicators, but not in outcome indicators. In particular, more competition in the hospital’s catchment area leads to more operation cancellations at short notice and more delays of hip fracture injury operations for elderly patients. Both results suggest that competition increases the utilization of operation capacity. At the same time, hospitals that face more competition perform check-ups for chronic patients more frequently and organize diagnostic processes more efficiently.