Competition and quality indicators in the health care sector: Empirical evidence from the Dutch hospital sector

Ramsis Croes, Yvonne Krabbe, Misja Mikkers

Research output: Contribution to journalArticleScientificpeer-review

14 Citations (Scopus)


There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008–2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.
Original languageEnglish
Pages (from-to)5-19
JournalEuropean Journal of Health Economics
Issue number1
Publication statusPublished - Jan 2018


  • competition
  • quality
  • hospitals
  • market structure


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