Who benefits when inertia is reduced? Competition, quality and returns to skill in health care markets

Increased competition creates incentives for health-care providers to improve quality by incorporating better inputs, like higher-skill physicians. However, because the supply of high-skill physicians is relatively inelastic in the short run, increases in competition may lead only to increases in returns to skill. I leverage a reform in Uruguay that increased competition among completely vertically integrated providers by reducing lock-in of consumers. Using administrative data on wages and hours and a measure of physicians’ skills based on test scores from medical school, I show that increased competition increased the returns to skill without strong evidence of an increase in quality.