Open Access Journal Article

Competition in French hospital: Does it impact the patient management in healthcare?

by Carine Milcent a,* orcid
Center for National Scientific Research (CNRS), Paris School of Economics, Paris, France
Author to whom correspondence should be addressed.
Received: 19 January 2024 / Accepted: 2 April 2024 / Published Online: 28 April 2024


This research paper examines changes in patient care management in acute care hospitals between 2001 and 2011. During this time, there were two opposing factors at play: the competition effect of the reform and the policymaker’s decision to reduce public hospitals across France. By studying the trends, it is evident that there has been a significant overall shift in patient care management during this period. This change could be attributed to the global competition effect and the concentration of in-patients in specific public facilities. Through the difference-in-difference method, the study analyzed time variations in the intensity of local competition. It was found that local competition had a negligible impact on patient care management. Additionally, the study revealed that there was a significant positive competition effect on high-technical procedures for the private sector, which is in line with the market segment where private sector hospitals have a leadership position and the pro-competitive reform intensified this position. The study also uncovered a negative competition effect on the length of stay for public hospitals. Prior to the implementation of the DRG-based payment reform, public sector hospitals were paid a global budget. However, after the reform was implemented, they had to shorten the length of stay to increase the number of stays. For-profit hospitals have always been paid based on the number of stays. The results are robust and consistent when alternative measures of local competition are used.

Copyright: © 2024 by Milcent. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (Creative Commons Attribution 4.0 International License). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.


Agence Nationale de la Recherche (ANR-17-EURE-001)

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ACS Style
Milcent, C. Competition in French hospital: Does it impact the patient management in healthcare?. Journal of Economic Analysis, 2024, 89.
AMA Style
Milcent C. Competition in French hospital: Does it impact the patient management in healthcare?. Journal of Economic Analysis; 2024:89.
Chicago/Turabian Style
Milcent, Carine 2024. "Competition in French hospital: Does it impact the patient management in healthcare?" Journal of Economic Analysis:89.
APA style
Milcent, C. (2024). Competition in French hospital: Does it impact the patient management in healthcare?. Journal of Economic Analysis, 89.

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