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Hospital prices and market structure in the hospital and insurance industries

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  • Moriya, Asako S.
  • Vogt, William B.
  • Gaynor, Martin

Abstract

There has been substantial consolidation among health insurers and hospitals, recently, raising questions about the effects of this consolidation on the exercise of market power. We analyze the relationship between insurer and hospital market concentration and the prices of hospital services. We use a national US dataset containing transaction prices for health care services for over 11 million privately insured Americans. Using three years of panel data, we estimate how insurer and hospital market concentration are related to hospital prices, while controlling for unobserved market effects. We find that increases in insurance market concentration are significantly associated with decreases in hospital prices, whereas increases in hospital concentration are non-significantly associated with increases in prices. A hypothetical merger between two of five equally sized insurers is estimated to decrease hospital prices by 6.7%.

Suggested Citation

  • Moriya, Asako S. & Vogt, William B. & Gaynor, Martin, 2010. "Hospital prices and market structure in the hospital and insurance industries," Health Economics, Policy and Law, Cambridge University Press, vol. 5(4), pages 459-479, October.
    • Handle: RePEc:cup:hecopl:v:5:y:2010:i:04:p:459-479_00
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    1. Berden, Carolien & Croes, R. & Kemp, R. & Mikkers, Misja & van der Noll, Rob & Shestalova, V. & Svitak, Jan, 2019. "Hospital Competition in the Netherlands : An Empirical Investigation," Discussion Paper 2019-008, Tilburg University, Tilburg Law and Economic Center.
    2. Rudy Douven & Monique Burger & Erik Schut, 2018. "Does managed competition constrain hospitals’ contract prices? Evidence from the Netherlands," CPB Discussion Paper 378, CPB Netherlands Bureau for Economic Policy Analysis.
    3. Eric Barrette & Gautam Gowrisankaran & Robert Town, 2020. "Countervailing Market Power and Hospital Competition," NBER Working Papers 27005, National Bureau of Economic Research, Inc.
    4. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    5. Trish, Erin E. & Herring, Bradley J., 2015. "How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?," Journal of Health Economics, Elsevier, vol. 42(C), pages 104-114.
    6. Peter Dohmen & Martin Ineveld & Aniek Markus & Liana Hagen & Joris Klundert, 2023. "Does competition improve hospital performance: a DEA based evaluation from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 999-1017, August.
    7. Douven, Rudy C.H.M. & Schut, Frederik T., 2011. "Pricing behaviour of nonprofit insurers in a weakly competitive social health insurance market," Journal of Health Economics, Elsevier, vol. 30(2), pages 439-449, March.
    8. Andrew Stocking & James Baumgardner & Melinda Buntin & Anna Cook, 2014. "Examining the Number of Competitors and the Cost of Medicare Part D: Working Paper 2014-04," Working Papers 45553, Congressional Budget Office.
    9. Kamyar Nasseh & John R. Bowblis & Marko Vujicic & Sean Shenghsiu Huang, 2020. "Consolidation in the dental industry: a closer look at dental payers and providers," International Journal of Health Economics and Management, Springer, vol. 20(2), pages 145-162, June.
    10. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    11. Brunt, Christopher S. & Bowblis, John R., 2014. "Health insurer market power and primary care consolidation," Economics Letters, Elsevier, vol. 125(1), pages 61-65.
    12. Leemore Dafny & Mark Duggan & Subramaniam Ramanarayanan, 2012. "Paying a Premium on Your Premium? Consolidation in the US Health Insurance Industry," American Economic Review, American Economic Association, vol. 102(2), pages 1161-1185, April.
    13. Donald Alexander & Jon Neill, 2015. "The Impact of Market Share on Health Insurance Premiums," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 43(4), pages 477-488, December.
    14. Jeffrey Clemens & Joshua D. Gottlieb, 2017. "In the Shadow of a Giant: Medicare’s Influence on Private Physician Payments," Journal of Political Economy, University of Chicago Press, vol. 125(1), pages 1-39.
    15. Rudy Douven & Monique Burger & Erik Schut, 2018. "Does managed competition constrain hospitals’ contract prices? Evidence from the Netherlands," CPB Discussion Paper 378.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    16. Scott E. Harrington, 2011. "The Continuing Debate on Health Insurance Reform," NFI Policy Briefs 2011-PB-09, Indiana State University, Scott College of Business, Networks Financial Institute.
    17. Pelech, Daria, 2017. "Dropped out or pushed out? Insurance market exit and provider market power in Medicare Advantage," Journal of Health Economics, Elsevier, vol. 51(C), pages 98-112.
    18. Gary M. Fournier, 2014. "Can Empirical Demand Models Assist in CON Comparative Reviews? A Case Study in Florida," Southern Economic Journal, John Wiley & Sons, vol. 81(1), pages 68-90, July.
    19. Laurie J. Bates & James I. Hilliard & Rexford E. Santerre, 2012. "Do Health Insurers Possess Market Power?," Southern Economic Journal, John Wiley & Sons, vol. 78(4), pages 1289-1304, April.
    20. Juan Esteban Carranza & Álvaro J. Riascos & Natalia Serna, 2017. "Market Power, Contracts and Outcomes: The Case of Patients with Long-Term Diseases in the Colombian Health Care System," Documentos de Trabajo 15283, Quantil.
    21. Kate Ho & Robin S. Lee, 2017. "Insurer Competition in Health Care Markets," Econometrica, Econometric Society, vol. 85, pages 379-417, March.
    22. Toren L. Fronsdal & Jay Bhattacharya & Suzanne Tamang, 2020. "Variation in Health Care Prices Across Public and Private Payers," NBER Working Papers 27490, National Bureau of Economic Research, Inc.

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