Hospital competition and surgical length of stay
J. C. Robinson, H. S. Luft, S. J. McPhee and S. S. Hunt
School of Public Health, University of California, Berkeley 94720.
The hypothesis that competitive pressures encourage hospitals to
accommodate patient and physician preferences for longer lengths of stay
was tested. Seven hundred forty-seven nonfederal short-term hospitals were
divided in terms of the number of neighboring hospitals within a 24-km
radius, and this measure of hospital concentration and competition was
measured against length of stay for ten surgical procedures, using 1982
data on 498454 patient discharges. Patient, physician, and hospital
characteristics associated with length of stay were controlled for.
Competition-related percentage increases in length of stay were identified
for all procedures, including total hip replacement (14.8%), transurethral
prostatectomy (13.9%), intestinal operations (14.0%), stomach operations
(14.7%), hysterectomy (6.9%), cholecystectomy (9.1%), hernia repair
(10.5%), appendectomy (8.4%), cardiac catheterization (22.9%), and coronary
artery bypass graft surgery (21.2%). It was concluded that there is a
strong association between the number of hospital competitors in the local
market and the average length of stay in US hospitals.
