Exploring the risks of fragmentation in health care markets - An analysis of inpatient care in Georgia

Private providers play an important role in health systems in low-and middle-income countries. In many such contexts, markets are characterized by a high number of relatively small private facilities. The potential risks from highly concentrated healthcare markets are well-researched, and feature in the "Theories of Harm" investigated by competition regulators. However, there is limited evidence on markets that exhibit substantial harms as a result of very low concentration. This paper explores the risks associated with such market fragmentation, drawing on the example of Georgia, which has a largely privatized provider network. We used a mixed-method study design to analyze the inpatient market in Georgia. Market structure was described using administrative data on bed capacity and discharge numbers and geo-location data on travel time between facilities. The implications of the market structure were explored through in-depth interviews (n = 35) with policymakers, healthcare managers, and local experts and an anonymous online survey of similar groups (n = 97). Georgia's inpatient sector is characterized by a high number of small hospitals in terms of bed numbers and inpatient volumes, mitigated to a limited degree by the presence of provider networks. Travel time to the 3rd nearest competitor was extremely short, ranging from 3 to 5 min in big cities to 10 min in small towns and 33 min in remote locations. The fragmented nature of the market, together with inadequate regulatory and purchasing mechanisms, was argued to exacerbate challenges in the availability and competence of clinical staff, while the financial challenges caused by intense competition encouraged wasteful marketing, harmful cost-cutting measures, and demand inducement. We present "Theories of Harm" from market fragmentation, and argue that an effective policy response requires market-shaping activities using regulatory, financing, and purchasing mechanisms to encourage appropriate levels of market consolidation and so enhance quality, efficiency, and effective governance

Actuarial science · Business · Economic growth · Economics · Environmental health · Fragmentation (computing · Health care · Inpatient care · Public economics · Computer Science · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Healthcare Policy and Management · Medicine · Gerontology

• Private provision of health services in Georgia

  Open Access•Mari Tvaliashvili, Mark Hellowell et al.•BMJ Global Health•2025

  Añadir item

• Towards technology-driven business continuity management in the saudi healthcare sector through security and operational risk management

  Open Access•Anas Ghassan Kanaan, Ahmad Al-Hawamleh et al.•Sustainable Futures•2025

  Añadir item

• Quality of basic maternal care functions in health facilities of five African countries

  Open Access•Margaret E Kruk, Hannah H Leslie et al.•The Lancet Global Health•2016

  Añadir item

• What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries

  Open Access•Maureen Mackintosh, Amos Channon et al.•The Lancet•2016

  Añadir item

• Evidence for overuse of medical services around the world

  Open Access•Shannon Brownlee, K Chalkidou et al.•The Lancet•2017

  Añadir item

• Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries

  Open Access•Loai Albarqouni, Morteza Arab‐Zozani et al.•BMJ Global Health•2022

  Añadir item

• Innovation in regulation of rapidly changing health markets

  Open Access•Gerald Bloom, Spencer Henson et al.•Globalization and Health•2014

  Añadir item

• Private Health Care in Nigeria

  Open Access•I Ogunbekun, A Ogunbekun et al.•Health Policy and Planning•1999

  Añadir item

• Investigating the nature of competition facing private healthcare facilities

  Open Access•Meenakshi Gautham, Katia Bruxvoort et al.•Health Policy and Planning•2019

  Añadir item

• Two Indias

  Open Access•Jishnu Das, Benjamin Daniels et al.•Social Science & Medicine•2022

  Añadir item