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Public health care providers and market competition: the case of Finnish occupational health services

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Abstract

Background

As reforms in publicly funded health systems rely heavily on competition, it is important to know if and how public providers react to competition. In many European countries, it is empirically difficult to study public providers in different markets, but in Finnish occupational health services, both public and private for-profit and non-profit providers co-exist. We studied possible differences in public providers’ performance (price, intensity of services, service mix—curative medical services/prevention, productivity and revenues) according to the competitiveness of the market.

Materials and methods

The Finnish Institute of Occupational Health (FIOH) collected data on clients, services and personnel for 1992, 1995, 1997, 2000 and 2004 from occupational health services (OHS) providers. Employers defray the costs of OHS and apply for reimbursement from the Social Insurance Institution (SII). The SII data was merged with FIOH’s questionnaire. The unbalanced panel consisted of about 230 public providers, totalling 1,164 observations. Local markets were constructed from several municipalities based on commuting practices and regional collaboration. Competitiveness of the market was measured by the number of providers and by the Herfindahl index. The effect of competition was studied by ordinary least square regression analysis and panel models.

Results

The more competitive the environment was for a public provider the higher were intensity, productivity and the share of medical care. Fixed panel models showed that these differences were not due to differences and changes in the competitiveness of the market. Instead, in more competitive markets public providers had higher unit prices and higher revenues.

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Notes

  1. The cost-weighted activity index (CWAI) has been used to measure overall NHS hospital efficiency. Many of the problems and flaws connected to this measure reported by Oliver [2] are less serious in the more homogenous Finnish OHS.

References

  1. Nickell, S.J.: Competition and corporate performance. J. Polit. Econ. 104(4), 724–746 (1996)

    Article  Google Scholar 

  2. Oliver, A.: The English National Health Service: 1979–2005. Health Econ. 14(S1), S75–S99 (2005)

    Article  Google Scholar 

  3. Glennerster, H.: Competition and quality in health care: the UK experience. Int. J. Qual. Health Care 10(5), 403–410 (1998)

    Article  Google Scholar 

  4. Shen, Y., Eggleston, K., Lau, J., Schmid, C.H.: Hospital ownership and financial performance: what explains the different findings in the empirical literature? Inquiry 44, 41–68 (2007)

    Google Scholar 

  5. Eggleston, K., Shen, Y., Lau, J., Schmid, C.H., Chan, J.: Hospital ownership and quality of care: what explains the different results in the literature? Health Econ. 17(12), 1345–1362 (2008)

    Article  Google Scholar 

  6. Cabral, L.M.B.: Introduction to industrial organization. MIT Press, Cambridge, MA (2002)

    Google Scholar 

  7. Nickell, S., Nicolitsas, D., Dryden, N.: What makes firms perform well? Eur. Econ. Rev. 41(3–5), 783–796 (1997)

    Article  Google Scholar 

  8. Nickell, S.: Product markets and labour markets. Labour Econ. 6(1), 1–20 (1999)

    Article  Google Scholar 

  9. Hart, O.D.: The market mechanism as an incentive scheme. Bell J. Econ. 14(2), 366–382 (1983)

    Article  Google Scholar 

  10. Hart, O.: Firms, contracts and financial structure. Clarendon, Oxford (1995)

    Book  Google Scholar 

  11. Shen, Y., Eggleston, K., Lau, J., Schmid, C.: Hospital ownership and financial performance: a quantitative research review. National Bureau of Economic Research, Cambridge, MA (2005)

    Google Scholar 

  12. Eggleston, K., Zeckhauser, R.: Government contracting for health care. In: Donahue, J.D., Nye, J.S.J. (eds.) Market-based governance: supply side, demand side, upside and downside, pp. 29–56. Brookings Institution Press, Washington, DC (2002)

    Google Scholar 

  13. Vining, A.R., Boardman, A.E.: Ownership versus competition: efficiency in public enterprise. Public Choice 73(2), 205–239 (1992)

    Article  Google Scholar 

  14. Kornai, J., Maskin, E., Roland, G.: Understanding the soft budget constraint. J. Econ. Lit. 41, 1095–1136 (2003)

    Article  Google Scholar 

  15. Segal, I.R.: Monopoly and soft budget constraint. Rand J. Econ. 29(3), 596–609 (1998)

    Article  Google Scholar 

  16. Gaynor, M., Haas-Wilson, D.: Change, consolidation, and competition in health care markets. J. Econ. Perspect. 13(1), 141–164 (1999)

    Article  Google Scholar 

  17. Keeler, E.B., Melnick, G., Zwanziger, J.: The changing effects of competition on non-profit and for-profit hospital pricing behavior. J. Health Econ. 18(1), 69–86 (1999)

    Article  Google Scholar 

  18. Dusheiko, M., Goddard, M., Gravelle, H., Jacobs, R.: Explaining trends in concentration of healthcare commissioning in the English NHS. Health Econ. 17(8), 907–926 (2008)

    Article  Google Scholar 

  19. Propper, C., Burgess, S., Gossage, D.: Competition and quality: evidence from the NHS internal market 1991–1999*. Econ. J. 118(525), 138–170 (2008)

    Article  Google Scholar 

  20. Propper, C., Burgess, S., Green, K.: Does competition between hospitals improve the quality of care? Hospital death rates and the NHS internal market. J. Public Econ. 88(7–8), 1247–1272 (2004)

    Article  Google Scholar 

  21. Kansaneläkelaitos: Kelan työterveyshuoltotilasto 2005 (Occupational Health Services—Statistics 2005). Kansaneläkelaitos (Social Insurance Institution), Helsinki (2008)

  22. Peurala, M., Manninen, P., Perkiö-Mäkelä, M., Kankaanpää, E., Husman, K.: Työterveyshuolto ja palvelujen käyttö (The usage of occupational health services). In: Kauppinen, T., Hanhela, R., Heikkilä, P., et al. (eds.) Työ ja terveys Suomessa 2006 (Work and Health in Finland in 2006), pp. 246–262. Työterveyslaitos, Helsinki (2007)

    Google Scholar 

  23. Manninen, P.: Työterveyshuolto Suomessa vuonna 2004—kehitystrendien tarkastelua (Occupational Health Services in Finland 2004—Reviewing the Development). Työterveyslaitos, Helsinki (2007)

    Google Scholar 

  24. Sosiaali- ja terveysministeriö: Työterveyshuollon maksu- ja korvausjärjestelmän uudistaminen (Renewing the Reimbursement System for Occupational Health Services). Työryhmämuistio (Working group memo) 29. Sosiaali- ja terveysministeriö (Ministry of Social Affairs and Health), Helsinki (1993)

  25. Robone, S., Zanardi, A.: Market structure and technology: evidence from the Italian National Health Service. Int. J. Health Care Finance Econ. 6, 215–236 (2006)

    Article  Google Scholar 

  26. Rosenman, R., Friesner, D.: Scope and scale inefficiencies in physician practices. Health Econ. 13(11), 1091–1116 (2004)

    Article  Google Scholar 

  27. Wholey, D., Feldman, R., Christianson, J.B., Engberg, J.: Scale and scope economies among health maintenance organizations. J. Health Econ. 15(6), 657–684 (1996)

    Article  Google Scholar 

  28. Christensen, E.W.: Scale and scope economies in nursing homes: a quantile regression approach. Health Econ. 13(4), 363–377 (2004)

    Article  Google Scholar 

  29. Aletras, V.H.: A comparison of hospital scale effects in short-run and long-run cost functions. Health Econ. 8(6), 521–530 (1999)

    Article  Google Scholar 

  30. Greene, W.H.: Econometric Analysis. Prentice Hall, Upper Saddle River, NJ (2003)

    Google Scholar 

  31. Park, H.M.: Linear Regression Model for Panel Data Using SAS, Stata, LIMDEP, and SPSS. Working Paper. The University Information Technology Services (UITS) Center for Statistical and Mathematical Computing, Indiana University, Bloomington, IN. http://www.indiana.edu/~statmath/stat/all/panel/index.html (2009). Accessed 18 Oct 2009

  32. Kankaanpää, E., Pulkkinen-Närhi, P.: Kunnallisen työterveyshuolllon palvelujärjestelmän rakenteet muuttuvat (Structural changes in public OHS provision). In: Manninen, P. (ed.) Työterveyshuolto Suomessa vuonna 2007 ja kehitystrendi 1997–2007 (Finnish Occupational Health Services in 2007 and Time Trend 1997–2007), pp. 70–73. Työterveyslaitos, Helsinki (2009)

    Google Scholar 

  33. Grytten, J., Sørensen, R.: Competition and dental services. Health Econ. 9(5), 447–461 (2000)

    Article  Google Scholar 

  34. Manninen, P.: Työterveyshuolto Suomessa vuonna 2007 ja kehitystrendi 1997–2007 (Finnish Occupational Health Services in 2007 and Time Trend 1997–2007). Työterveyslaitos (Finnish Institute of Occupational Health), Helsinki (2009)

    Google Scholar 

  35. Sari, N.: Efficiency outcomes of market concentration and managed care. Int. J. Ind. Organ. 21(10), 1571–1589 (2003)

    Article  Google Scholar 

  36. Rice, T., Biles, B.: Reconsidering the role of competition in health care markets: introduction. J. Health Polit. Policy Law 25(5), 863 (2000)

    Article  Google Scholar 

  37. Dranove, D., Satterthwaite, M.A.: The industrial organization of health care markets. In: Culyer, A.J., Newhouse, J.P. (eds.) Handbook of Health Economics, pp. 1094–1139. Elsevier, Amsterdam (2000)

    Google Scholar 

  38. McNulty, P.J.: Economic theory and the meaning of competition. Q. J. Econ. 82(4), 639–656 (1968)

    Article  Google Scholar 

  39. Dranove, D., Lindrooth, R., White, W.D., Zwanziger, J.: Is the impact of managed care on hospital prices decreasing? J. Health Econ. 27(2), 362–376 (2008)

    Article  Google Scholar 

  40. Brown III, S.H.: Managed care and technical efficiency. Health Econ. 12(2), 149–158 (2003)

    Article  Google Scholar 

  41. Hart, O., Shleifer, A., Vishny, R.W.: The proper scope of government: theory and an application to prisons. Q. J. Econ. 112(4), 1127–1161 (1997)

    Article  Google Scholar 

  42. Gosden, T., Forland, F., Kristiansen, I.S., Sutton, M., Leese, B., Giuffrida, A., Sergison, M., Pedersen, L.: Impact of payment method on behaviour of primary care physicians: a systematic review. J. Health Serv. Res. Policy 6(1), 44–55 (2001)

    Article  Google Scholar 

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Acknowledgments

Eila Kankaanpää is grateful for the financial support she received from the Finnish Post Graduate School in Social and Health Policy, Management and Economics. Collaboration with the personnel at the Social Insurance Institution was excellent. We thank the audience, especially Oddvar Karbøe, for constructive comments and criticism in the Joint meeting of the UK Health Economists’ Study Group (HESG) and Nordic HESG, Aberdeen, Scotland, UK, 27–29 August 2008. We thank Ms. Alice Lehtinen for language editing.

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Authors and Affiliations

  1. Department of Health and Social Management, University of Eastern Finland, POB 1627, 70711, Kuopio, Finland

    Eila Kankaanpää, Ismo Linnosmaa & Hannu Valtonen

  2. Finnish Institute of Occupational Health, Kuopio, Finland

    Eila Kankaanpää

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  1. Eila Kankaanpää
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  2. Ismo Linnosmaa
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Correspondence to Eila Kankaanpää.

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Kankaanpää, E., Linnosmaa, I. & Valtonen, H. Public health care providers and market competition: the case of Finnish occupational health services. Eur J Health Econ 12, 3–16 (2011). https://doi.org/10.1007/s10198-010-0217-7

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  • DOI: https://doi.org/10.1007/s10198-010-0217-7

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