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Objectives This study analyzes the results of empirical studies on the impact of hospital competition (rivalry and market pressure) on the quality of care in European countries. Methods A systematic review has been conducted according to the Preferred Reporting Items for Systematic Reviewing and Meta-Analysis (PRISMA) guidelines, using the following online databases: PubMed, ScienceDirect, Wiley Online Library, and Google Scholar. The search protocol covers studies published in English between January 2015 and mid-April 2024. Results Eight out of 14 eligible studies document significant positive associations, at least in the short term, between hospital competition and the quality of care measured through objective outcome indicators. Of the other six, one study demonstrates a negative relationship in a specific context. The findings of the remaining five studies are heterogeneous and context-dependent (two out of five) or suggest no discernible association between the two examined phenomena (three out of five). The respective contexts with positive, negative, or no statistically significant associations have been identified. Conclusions The most essential impacts of competition on the quality of hospital care have been summarized, and avenues for future research and policy implications have been discussed.