تاثیر رقابت بر کیفیت و قیمت در بازار خانه مراقبت های انگلیسی

This study assesses the impact of competition on quality and price in the English care/nursing homes market. Considering the key institutional features, we use a theoretical model to assess the conditions under which further competition could increase or reduce quality. A dataset comprising the population of 10,000 care homes was used. We constructed distance/travel-time weighted competition measures. Instrumental variable estimations, used to account for the endogeneity of competition, showed quality and price were reduced by greater competition. Further analyses suggested that the negative quality effect worked through the effect on price – higher competition reduces revenue which pushes down quality.

Market mechanisms and competition has been introduced into the long-term care systems of many countries, replacing hitherto public bureaucratic, non-profit or other non-market arrangements (Fernandez et al., 2011). The importance of markets in the care homes sector in England has increased markedly in the last 30 years; by 2010 over 90% of all placements were made in the care homes market, with only a residual number of (publicly-supported) residents placed directly in publicly-owned homes (Laing & Buisson, 2010). This paper seeks to assess the impact of market competitiveness on quality and prices. Whole-market metrics of concentration indicate that the English care homes market is highly competitive (Forder and Allan, 2011).

The results of the price estimations – the partial reduced form, (9) – are presented in Table 3. Table 4 has the quality estimation results i.e. of (8), including both the LPM and ordered probit model (OP) results. We used both a distance-weighted HHI (“HHIa”) and the distance and travel time-adjusted version (“HHIb”).