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Is Hospital Competition Socially Wasteful?

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  • Daniel P. Kessler
  • Mark B. McClellan

Abstract

We study the consequences of hospital competition for Medicare beneficiaries' heart attack care from 1985 to 1994. We examine how relatively exogenous determinants of hospital choice such as travel distances influence the competitiveness of hospital markets, and how hospital competition interacts with the influence of managed care organizations to affect the key determinants of social welfare expenditures on treatment and patient health outcomes. In the 1980s, the welfare effects of competition were ambiguous; but in the 1990s, competition unambiguously improves social welfare. Increasing HMO enrollment over the sample period partially explains the dramatic change in the impact of hospital competition.

Suggested Citation

  • Daniel P. Kessler & Mark B. McClellan, 1999. "Is Hospital Competition Socially Wasteful?," NBER Working Papers 7266, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:7266
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    References listed on IDEAS

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    Cited by:

    1. Tomas J. Philipson & Richard A. Posner, 2009. "Antitrust in the Not-for-Profit Sector," Journal of Law and Economics, University of Chicago Press, vol. 52(1), pages 1-18, February.
    2. Osmis Areda Habte & Håkan J. Holm, 2022. "Competition Makes Inspectors More Lenient: Evidence from the Motor Vehicle Inspection Market," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 61(1), pages 45-72, August.
    3. Mark G. Duggan, 2000. "Hospital Ownership and Public Medical Spending," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(4), pages 1343-1373.
    4. Victor R. Fuchs & Mark B. McClellan & Jonathan S. Skinner, 2004. "Area Differences in Utilization of Medical Care and Mortality among US Elderly," NBER Chapters, in: Perspectives on the Economics of Aging, pages 367-414, National Bureau of Economic Research, Inc.
    5. Baker, Matthew C. & Stratmann, Thomas, 2021. "Barriers to entry in the healthcare markets: Winners and Losers from certificate-of-need laws," Socio-Economic Planning Sciences, Elsevier, vol. 77(C).
    6. Daniel P. Kessler & Mark B. McClellan, 2000. "Medical Liability, Managed Care, and Defensive Medicine," NBER Working Papers 7537, National Bureau of Economic Research, Inc.
    7. David Bardey & Giancarlo Buitrago, 2015. "Integración vertical en el sector de la salud colombiano," Documentos CEDE 14069, Universidad de los Andes, Facultad de Economía, CEDE.
    8. David Meltzer & Jeanette Chung, 2002. "Effects of Competition Under Prospective Payment on Hospital Costs Among High- and Low-Cost Admissions: Evidence from California, 1983 and 1993," NBER Chapters, in: Frontiers in Health Policy Research, Volume 5, pages 53-102, National Bureau of Economic Research, Inc.
    9. Sherry Glied, 2003. "Health Care Costs: On the Rise Again," Journal of Economic Perspectives, American Economic Association, vol. 17(2), pages 125-148, Spring.
    10. Shen, Yu-Chu, 2003. "The effect of financial pressure on the quality of care in hospitals," Journal of Health Economics, Elsevier, vol. 22(2), pages 243-269, March.
    11. Yanfei Zhou & Wataru Suzuki, 2006. "Market Concentration, Efficiency, and Quality in the Japanese Home Help Industry," NBER Chapters, in: Health Care Issues in the United States and Japan, pages 147-164, National Bureau of Economic Research, Inc.

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