In this paper we explore the geographical scope of hospital competition on quality, using Italian data on over 207,000 patients admitted to 174 hospitals located in the Lombardy region in the years 2008–2014. We propose an economic framework that incorporates both local and global forms of quality competition among hospitals, the latter emerging from periodically released hospital performance rankings. Under this framework, we derive the hospital reaction functions and, accordingly, we characterize the structure of interdependence among hospital qualities. We employ recent methods from the graphical modelling literature to estimate the set of local rivals for each hospital, as well as the degree of global interdependence among hospitals. Consistently with our micro-founded framework, our results show a significant positive degree of short- and long-range dependence, suggesting the existence of forms of local and global competition amongst hospitals with relevant implications for health care policy.

在本文中，我们使用意大利数据来探讨医院质量竞争的地理范围，这些数据涉及 2008 年至 2014 年伦巴第地区 174 家医院收治的 207,000 多名患者。我们提出了一个经济框架，它结合了医院之间的本地和全球形式的质量竞争，后者来自定期发布的医院绩效排名。在此框架下，我们推导出医院反应函数，并据此描述医院质量之间相互依存的结构。我们采用图形建模文献中的最新方法来估计每家医院的本地竞争对手集，以及医院之间的全球相互依赖程度。与我们的微观基础框架一致，