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Debt and Bargaining Outcomes: Evidence from U.S. Hospitals

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  • Mitch Towner

    (Eller College of Management, University of Arizona, Tucson, Arizona 85721)

Abstract

Using the healthcare industry as a novel laboratory, I study whether a firm’s use of debt enhances its bargaining power during negotiations with nonfinancial stakeholders. I find that reimbursement rates negotiated between a hospital and insurers for two homogeneous procedures are higher when the hospital has more debt. This relation is stronger among hospitals with less bargaining power relative to insurers ex ante. The evidence is consistent with the idea that debt improves a firm’s bargaining power.

Suggested Citation

  • Mitch Towner, 2020. "Debt and Bargaining Outcomes: Evidence from U.S. Hospitals," Management Science, INFORMS, vol. 66(5), pages 2083-2098, May.
    • Handle: RePEc:inm:ormnsc:v:66:y:2020:i:5:p:2083-2098
    DOI: 10.1287/mnsc.2019.3291
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    1. Dasgupta, Sudipto & Nanda, Vikram, 1993. "Bargaining and brinkmanship : Capital structure choice by regulated firms," International Journal of Industrial Organization, Elsevier, vol. 11(4), pages 475-497.
    2. DeAngelo, Harry & DeAngelo, Linda, 1991. "Union negotiations and corporate policy *1: A study of labor concessions in the domestic steel industry during the 1980s," Journal of Financial Economics, Elsevier, vol. 30(1), pages 3-43, November.
    3. Efraim Benmelech & Nittai K. Bergman & Ricardo J. Enriquez, 2012. "Negotiating with Labor under Financial Distress," The Review of Corporate Finance Studies, Society for Financial Studies, vol. 1(1), pages 28-67.
    4. Matthew S. Lewis & Kevin E. Pflum, 2017. "Hospital systems and bargaining power: evidence from out-of-market acquisitions," RAND Journal of Economics, RAND Corporation, vol. 48(3), pages 579-610, August.
    5. Perotti, Enrico C & Spier, Kathryn E, 1993. "Capital Structure as a Bargaining Tool: The Role of Leverage in Contract Renegotiation," American Economic Review, American Economic Association, vol. 83(5), pages 1131-1141, December.
    6. David A. Matsa, 2010. "Capital Structure as a Strategic Variable: Evidence from Collective Bargaining," Journal of Finance, American Finance Association, vol. 65(3), pages 1197-1232, June.
    7. Mitchell A. Petersen & Raghuram G. Rajan, 1995. "The Effect of Credit Market Competition on Lending Relationships," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 110(2), pages 407-443.
    8. Jensen, Michael C, 1986. "Agency Costs of Free Cash Flow, Corporate Finance, and Takeovers," American Economic Review, American Economic Association, vol. 76(2), pages 323-329, May.
    9. Israel, Ronen, 1991. "Capital Structure and the Market for Corporate Control: The Defensive Role of Debt Financing," Journal of Finance, American Finance Association, vol. 46(4), pages 1391-1409, September.
    10. Shantanu Banerjee & Sudipto Dasgupta & Yungsan Kim, 2008. "Buyer–Supplier Relationships and the Stakeholder Theory of Capital Structure," Journal of Finance, American Finance Association, vol. 63(5), pages 2507-2552, October.
    11. Chu, Yongqiang, 2012. "Optimal capital structure, bargaining, and the supplier market structure," Journal of Financial Economics, Elsevier, vol. 106(2), pages 411-426.
    12. Avi Dor & Michael Grossman & Siran M. Koroukian, 2004. "Hospital Transaction Prices and Managed-Care Discounting for Selected Medical Technologies," American Economic Review, American Economic Association, vol. 94(2), pages 352-356, May.
    13. Melnick, Glenn A. & Zwanziger, Jack & Bamezai, Anil & Pattison, Robert, 1992. "The effects of market structure and bargaining position on hospital prices," Journal of Health Economics, Elsevier, vol. 11(3), pages 217-233, October.
    14. Elena Simintzi & Vikrant Vig & Paolo Volpin, 2015. "Labor Protection and Leverage," The Review of Financial Studies, Society for Financial Studies, vol. 28(2), pages 561-591.
    15. Mark Duggan, 2002. "Hospital Market Structure and the Behavior of Not-For-Profit Hospitals," RAND Journal of Economics, The RAND Corporation, vol. 33(3), pages 433-446, Autumn.
    16. DeAngelo, H,, 1991. "Union Negotiation and Corporate Policy : A Study of Labor "Givebacks" in the Domestic Stel Industry During the 1980s," Papers 91-24, Southern California - School of Business Administration.
    17. Myers, Stewart C., 1977. "Determinants of corporate borrowing," Journal of Financial Economics, Elsevier, vol. 5(2), pages 147-175, November.
    18. Kale, Jayant R. & Shahrur, Husayn, 2007. "Corporate capital structure and the characteristics of suppliers and customers," Journal of Financial Economics, Elsevier, vol. 83(2), pages 321-365, February.
    19. Titman, Sheridan, 1984. "The effect of capital structure on a firm's liquidation decision," Journal of Financial Economics, Elsevier, vol. 13(1), pages 137-151, March.
    20. Stephen G. Bronars & Donald R. Deere, 1991. "The Threat of Unionization, the Use of Debt, and the Preservation of Shareholder Wealth," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 106(1), pages 231-254.
    21. Wedig, Gerard J & Hassan, Mahmud & Morrisey, Michael A, 1996. "Tax-Exempt Debt and the Capital Structure of Nonprofit Organizations: An Application to Hospitals," Journal of Finance, American Finance Association, vol. 51(4), pages 1247-1283, September.
    22. Klasa, Sandy & Maxwell, William F. & Ortiz-Molina, Hernán, 2009. "The strategic use of corporate cash holdings in collective bargaining with labor unions," Journal of Financial Economics, Elsevier, vol. 92(3), pages 421-442, June.
    23. Hennessy, Christopher A. & Livdan, Dmitry, 2009. "Debt, bargaining, and credibility in firm-supplier relationships," Journal of Financial Economics, Elsevier, vol. 93(3), pages 382-399, September.
    24. Wedig, Gerard J., 1988. "Health status and the demand for health : Results on price elasticities," Journal of Health Economics, Elsevier, vol. 7(2), pages 151-163, June.
    25. A. J. Culyer & J. P. Newhouse (ed.), 2000. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, edition 1, volume 1, number 1.
    26. Dasgupta, Sudipto & Sengupta, Kunal, 1993. "Sunk Investment, Bargaining and Choice of Capital Structure," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 34(1), pages 203-220, February.
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