Shortell S & Hughes E, (1988)

‘The Effects of Regulation, Competition, and Ownership on Mortality Rates among Hospital Inpatients’

New Engalnd Journal of Medicine, Vol. 318, No. 17, pp. 1100-1107.

• Empirical analysis of the impact of regulation and competition on hospital mortality rates.
• Uses national U.S. cross-section data to analyse whether hospitals facing severe regulatory constraints, strong competitive pressures, or both may respond to these forces in ways associated with poorer outcomes for patients.

Key results:

• Competition among hospitals in the same market area was not significantly associated with mortality rates.
• Market penetration by HMOs was significantly and positively associated with higher mortality rates.

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