National Trends in Market Competition for Hospital-Based Pediatric Services: 2011-2018

Area of Science:

• Health economics
• Pediatric healthcare services
• Market analysis

Background:

• Understanding market competition is crucial for healthcare policy and patient access.
• Previous research has not comprehensively analyzed trends in pediatric hospital service line competition.
• Defining hospital markets is complex and can influence findings.

Purpose of the Study:

• To analyze national trends in market competition for pediatric hospital service lines in the United States.
• To compare characteristics of competitive versus concentrated markets for these services.
• To assess how different market definitions impact competition analysis.

Main Methods:

• The study defined hospital markets as competitive (≥5 hospitals), concentrated (1-4 hospitals), or unavailable (0 hospitals) for specific pediatric services.
• Trends in market structure were assessed by comparing the pediatric population share in competitive markets in 2018 versus 2011.
• Three market operationalization approaches were used: Healthcare Referral Regions (HRR), Neonatal Intensive Care Regions (NICR), and Pediatric Emergency Referral Regions (PERR).

Main Results:

• The proportion of the pediatric population in competitive markets increased for Neonatal Intensive Care Units (NICU), Pediatric Intensive Care Units (PICU), and Pediatric Emergency Departments (PED).
• Market competitiveness for General Pediatric Inpatient Units (GPIU) showed variable trends depending on the market definition used.
• Competitive markets, compared to concentrated ones, had smaller population declines, larger non-white populations, and more children's hospitals.

Conclusions:

• Market competitiveness for pediatric hospital services is diverse, influenced by service type, demographics, and market definition.
• Further research is needed to determine if competitive markets yield better outcomes and lower prices.
• The findings suggest a need to consider patient protections in concentrated pediatric healthcare markets.