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Competition and quality of care under regulated fees: evidence from Ghana
Adolf Kwadzo Dzampe1,2, Shingo Takahashi3
1Japan Development Service (JDS) PhD Fellow, Graduate School for International Development and Cooperation, Hiroshima University, 1-5-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8529, Japan. forster@iuj.ac.jp.
Insights
Increased doctor density in Ghana improves healthcare quality for hypertension patients, reducing hospitalizations and in-hospital deaths. This suggests competition can enhance care outcomes.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Empirical evidence on healthcare competition's impact on quality is limited and mixed.
- Understanding competition's effect on health outcomes is crucial for policy development.
Purpose of the Study:
- To investigate the relationship between healthcare competition and quality of care in Ghana.
- To determine if increased doctor-to-population ratio improves health outcomes for hypertension patients.
Main Methods:
- Utilized administrative claims data for hypertension patients from 2017-2019.
- Employed an instrumental variable method to assess competition's effect.
- Measured competition by the district doctor-to-population ratio.
Main Results:
- An increased doctor-to-population ratio was associated with improved quality of care.
- Higher doctor density led to decreased hospitalization rates for ambulatory care sensitive conditions.
- Increased doctor density correlated with a reduced risk of in-hospital deaths.
Conclusions:
- Healthcare competition, indicated by higher doctor density, can improve care quality in Ghana.
- Findings suggest potential welfare benefits from physician-induced demand and increased physician availability.
- Policy recommendations include considering the benefits of induced medical services and increasing physician training.
Background:
How competition affects the quality of care is still not well understood empirically because of limited and mixed results. This study examined whether competition leads to higher or lower quality health outcomes in Ghana.
Methods:
We used administrative claims data of hypertension patients for 2017 - 2019 (36 months), and an instrumental variable method to examine the effect of competition, measured as an increase in district doctor-to-population ratio on hospital-level ambulatory care sensitive condition hospitalization and in-hospital death rates.
Results:
Overall, we found that an increase in doctor density improves the quality of care for hypertension patients in Ghana. That is, when there are more doctors, fewer patients are hospitalized, and the risk of in-hospital deaths decreases. This result is robust to analyses at the individual and district population levels for ambulatory care sensitive hospitalizations rate.
Conclusions:
Our findings suggest that in the presence of physician-induced demand, competition can lead to improvement in the quality of care, possibly through improved access to healthcare and increased physician time and contact per patient. Future health policies need to consider possible welfare benefits of induced medical services and training more doctors.
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