Different Outcomes and Settings

The goal for today’s class is to consider other outcomes where competition may play a role (not just price) and some specific settings where competition may work differently. We’ll focus on the following areas and papers for today’s class.

Competition and Quality

While most studies focus on the relationship between competition and price, there is a growing literature on the relationship between competition and quality. We’ll discuss Gaynor, Moreno-Serra, and Propper (2013) and Barker, Watt, and Tranmer (2022) as examples of work in this area.

Competition and Other Outcomess

In addition to prices and quality, competition can influence hospitals in many different ways. Eliason et al. (2020) studies mergers in the context of dialysis (effectively this is a study of market power and quality, they look at specific treatment decisions that happen to be negatively correlated with quality). Craig, Grennan, and Swanson (2021) studies the effect of mergers on bargaining power for high-price inputs (medicald devices, in this case).

Competition in Rural Settings

In the U.S., rural hospitals have struggled in recent years, with many hospitals closing. Understanding the effects of such closures and what we might want to do about it is an active area of policy interest. We’ll discuss Carroll et al. (2023) as a review of this clinical setting, and Fischer, Royer, and White (2024) as a recent paper in this area.

References

Barker, Eliane H., Jenny Watt, and Joan Tranmer. 2022. “The Impact of Hospital Closures and Mergers on Patient Welfare.” {SSRN} {Scholarly} {Paper}. Rochester, NY. https://doi.org/10.2139/ssrn.4291718.
Carroll, Caitlin, Rhiannon Euhus, Nancy Beaulieu, and Michael E. Chernew. 2023. “Hospital Survival In Rural Markets: Closures, Mergers, And Profitability.” Health Affairs 42 (4): 498–507. https://doi.org/10.1377/hlthaff.2022.01191.
Craig, Stuart V., Matthew Grennan, and Ashley Swanson. 2021. “Mergers and Marginal Costs: New Evidence on Hospital Buyer Power.” The RAND Journal of Economics 52 (1): 151–78. https://doi.org/10.1111/1756-2171.12365.
Eliason, Paul J, Benjamin Heebsh, Ryan C McDevitt, and James W Roberts. 2020. “How Acquisitions Affect Firm Behavior and Performance: Evidence from the Dialysis Industry.” Quarterly Journal of Economics 135 (1): 221–67.
Fischer, Stefanie, Heather Royer, and Corey White. 2024. “Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the U.S.” American Economic Journal: Applied Economics. https://doi.org/10.1257/app.20220341.
Gaynor, Martin, Rodrigo Moreno-Serra, and Carol Propper. 2013. “Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service.” American Economic Journal: Economic Policy 5 (4): 134–66.