Date of Conferral

2020

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Health Services

Advisor

James Rohrer

Abstract

Hospitals, along with other health care providers, are a central part of every health care system and responsible for a great share of healthcare expenditure. In the United States, the cost of health care is much higher than it is anywhere else. High expenditures for hospital services could reduce the resources available for primary care and other services that could do more for population health. The purpose of this study was to explore the competition among general medical and surgical hospitals in the Deep Southern states of Mississippi, Alabama, Georgia, South Carolina, and Louisiana to determine if increasing the level of competition was associated with more services being offered. The design of the study was a correlational analysis of cross-sectional data, employing multiple regression guided by the Medical Arms Race (MAR) theory. The dependent variable was the total number of services offered, and the primary independent variable was market concentration, as measured by the Herfindahl-Hirschman Index. The covariates were age, poverty level, and urban/rural location. The number of services in each general medical and surgical hospital in Mississippi, Alabama, Georgia, South Carolina, and Louisiana were measured to determine whether increasing levels of competition resulted in more services being offered. The findings of this study strongly support the MAR theory showing that the dependent variable and the primary independent variable were significantly correlated with higher market concentration being associated with fewer services being offered. The results suggest that reducing competition could decrease duplication of hospital services.

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