Spatial analysis of the impact on competition among health care providers across the alternative health care delivery systems

• Project/Area Number: 26780183
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Public finance/Public economy
• Research Institution: Hyogo University of Health Sciences
• Principal Investigator: NISHIDA Kiheiji 兵庫医療大学, 共通教育センター, 講師 (50631652)
• Research Collaborator: MATSUURA Nariaki 大阪大学大学院医学系研究科, 医療経済経営学寄付講座, 特任教授 (70190402) ; HAMADA Yoshinosuke 大阪大学大学院医学系研究科, 医療経済経営学寄付講座, 特任准教授 (10362683) ; KAWAKAMI Tetsu 近畿大学, 経済学部, 教授 (60402674) ; YAMADA Eri 近畿大学, 総合社会学部, 講師 (30706742)
• Project Period (FY): 2014-04-01 – 2016-03-31
• Project Status: Completed (Fiscal Year 2015)
• Budget Amount: ¥2,210,000 (Direct Cost: ¥1,700,000、Indirect Cost: ¥510,000); Fiscal Year 2015: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000); Fiscal Year 2014: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000)
• Keywords: 出来高払い制度 / 包括払い制度 / 医師誘発需要 / 医療施設の空間競争 / 医師誘発需要仮設 / 医療施設の空間的競争 / 適切な医療圏域の設定 / 空間的競争モデル / DPC/PDPS / 出来高払い制

Outline of Final Research Achievements

Regional mal-distribution of healthcare providers such as hospitals and clinics is conspicuous in Japan. This study analyzes whether Japan's fee-for-service reimbursement system (FFSRS) or its diagnosis procedure combination/per-diem payment system (DPC/PDPS) is the better solution for the problem, with reference to the Hotelling-style spatial competition model. Under FFSRS, we also consider two modes of competition: the Stackelberg case, in which providers can control the number of hospital visits, and the Nash case, in which providers cannot do so. Results indicate that competition under DPC/PDPS is the most intensive of the three modes of competition. To relieve the locational concentration of providers, we also find that DPC/PDPS has a better mechanism than FFSRS.

Research Products

• [Presentation] On Variance-Stabilizing Multivariate Nonparametric Regression Estimation (2016)
  • Author(s): Kiheiji NISHIDA, Yuichiro Kanazawa
  • Organizer: 日本オペレーションズ・リサーチ学会「数理的発想とその実践」研究部会 第5回研究集会
  • Place of Presentation: しきぶ温泉湯楽里(福井県越前市)
  • Year and Date: 2016-02-07
• [Presentation] 医療施設の空間的競争 (2015)
  • Author(s): 西田 喜平次
  • Organizer: 大阪大学医療問題研究会(第5回)
  • Place of Presentation: 大阪大学中之島センター(大阪府大阪市)
  • Year and Date: 2015-11-26
• [Presentation] A Study on the Optimal Size of Medical Service Area:Spatial Competition Model Approach (2015)
  • Author(s): Kiheiji Nishida, Tetsu Kawakami
  • Organizer: 62nd Annual North American Meetings of the Regional Science Association International
  • Place of Presentation: Hilton Portland & Executive Tower (Portland, Oregon, アメリカ合衆国).
  • Year and Date: 2015-11-14
  • Int'l Joint Research
• [Presentation] A Comparison between the Two Alternative Healthcare Payment Systems: Spatial Competition Model Approach (2015)
  • Author(s): Kiheiji NISHIDA
  • Organizer: 第9回実証的なモラルサイエンス研究集会
  • Place of Presentation: 大阪府立大学 I-siteなんば, (大阪府大阪市)
  • Year and Date: 2015-03-18
• [Presentation] A Comparison Between The Two Healthcare Delivery Systems : Spatial Competition Model Approach (2015)
  • Author(s): Kiheiji NISHIDA
  • Organizer: Western Regional Science Association, 54th annual meeting.
  • Place of Presentation: Loews Ventana Canyon Resort in Tucson, (Arisona, U.S.A.)
  • Year and Date: 2015-02-18