| dc.description.abstract | This research explores the impact of market competition on the utilization of out-of-pocket medical devices and quality of care. This study focuses on patients who received percutaneous coronary intervention (PCI) and had at least one coronary stent inserted from 2007 to 2017. Firstly, this research examines the influence of market competition and physicians’ preference on whether patients will use drug-eluting stents (DES) in therapy. Subsequently, using market competition in healthcare as an explanatory variable, this study observes its impact on patients’ medical outcomes, which can be regarded as a proxy variable for the quality of care. Lastly, the mediation analysis in the structural equation model will be used to evaluate the composition of the impact of market competition on quality of care, including the direct and indirect effects mediated through DES usage, thereby exploring the primary source of quality improvement in the market.
Based on the empirical results, this study finds a positive correlation between market competition, physicians’ preference, and the utilization of DES, with physicians’ preference exerting a stronger influence than other explanatory variables. Additionally, the model shows that the market competition will contribute to a better quality of care, indicating the presence of quality competition in the recent market and increasing the usage of DES, aligning with the phenomenon of the medical arms race (MAR). However, the mediation analysis shows that the indirect effect drives quality enhancement in a moderately competitive market via DES utilization.
As discussed above, although market competition can enhance the quality of care, it also brings out the changes in the utilization of medical devices and the phenomenon of MAR simultaneously, which might not benefit vulnerable groups. Whereas, there are still some limitations in this research, and future studies are encouraged to adopt more sophisticated methods and models for a deeper understanding of the effects of healthcare market competition on the utilization of out-of-pocket payment medical devices and quality of care. | en_US |