We study the impact of exposing hospitals in a National Health Service (NHS) to non-price competition by exploiting a patient choice reform in Norway in 2001. The reform facilitates a difference-in-difference approach due to plausibly exogenous (geographical) variation in pre-reform market structure. Employing rich, administrative data, covering the universe of hospital admissions from 1998 to 2005, we estimate models with hospital and treatment (DRG) fixed-effects and use only emergency admissions to limit patient selection issues. The results show that hospitals in more competitive areas have a sharper reduction in AMI mortality but no effect on stroke mortality. We also find that exposure to competition reduces all-cause mortality, shortens length of stay, but increases readmissions, though the effects are small in magnitude. In years with high (DRG) prices, the negative effect on readmissions almost vanishes. Finally, exposure to competition tends to reduce waiting times and increase admissions, but the effects must be interpreted with care as the outcomes include elective treatments.

我们通过利用 2001 年挪威的患者选择改革，研究了将国家卫生服务 (NHS) 中的医院置于非价格竞争中的影响。改革前的市场结构。利用涵盖 1998 年至 2005 年所有住院人数的丰富的行政数据，我们估计具有医院和治疗 (DRG) 固定效应的模型，并仅使用急诊入院人数来限制患者选择问题。结果表明，在竞争更激烈的地区，医院的 AMI 死亡率下降幅度更大，但对卒中死亡率没有影响。我们还发现，竞争减少了全因死亡率，缩短了住院时间，但增加了再入院率，尽管影响很小。在 (DRG) 价格高的年份，对再入院的负面影响几乎消失。最后，参与竞争往往会减少等待时间并增加入院率，但必须谨慎解释其影响，因为结果包括选择性治疗。