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The Impact of Organizational Boundaries on Healthcare Coordination and Utilization

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Listed:
  • Leila Agha
  • Keith Marzilli Ericson
  • Xiaoxi Zhao

Abstract

We measure organizational concentration—the distribution of a patient's healthcare across organizations—to examine how firm boundaries affect healthcare efficiency. First, when patients move to regions where outpatient visits are typically concentrated within a small set of firms, their healthcare utilization falls. Second, for patients whose PCPs exit the market, switching to a PCP with 1 standard deviation higher organizational concentration reduces utilization by 21%. This finding is robust to controlling for the spread of healthcare across providers. Increases in organizational concentration predict improvements in diabetes care and are not associated with greater use of emergency department or inpatient care.

Suggested Citation

  • Leila Agha & Keith Marzilli Ericson & Xiaoxi Zhao, 2020. "The Impact of Organizational Boundaries on Healthcare Coordination and Utilization," NBER Working Papers 28179, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:28179
    Note: AG CF EH IO LE LS PE
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    1. Hart, Oliver & Moore, John, 1990. "Property Rights and the Nature of the Firm," Journal of Political Economy, University of Chicago Press, vol. 98(6), pages 1119-1158, December.
    2. Brigham Frandsen & Michael Powell & James B. Rebitzer, 2019. "Sticking points: common‐agency problems and contracting in the US healthcare system," RAND Journal of Economics, RAND Corporation, vol. 50(2), pages 251-285, June.
    3. Wouter Dessein, 2014. "Incomplete Contracts and Firm Boundaries: New Directions," The Journal of Law, Economics, and Organization, Oxford University Press, vol. 30(suppl_1), pages 13-36.
    4. Enghin Atalay & Ali Horta?su & Chad Syverson, 2014. "Vertical Integration and Input Flows," American Economic Review, American Economic Association, vol. 104(4), pages 1120-1148, April.
    5. Fadlon, Itzik & Van Parys, Jessica, 2020. "Primary care physician practice styles and patient care: Evidence from physician exits in Medicare," Journal of Health Economics, Elsevier, vol. 71(C).
    6. Emily Oster, 2019. "Unobservable Selection and Coefficient Stability: Theory and Evidence," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 187-204, April.
    7. Leila Agha & Keith Marzilli Ericson & Kimberley H. Geissler & James B. Rebitzer, 2018. "Team Formation and Performance: Evidence from Healthcare Referral Networks," NBER Working Papers 24338, National Bureau of Economic Research, Inc.
    8. Seru, Amit, 2014. "Firm boundaries matter: Evidence from conglomerates and R&D activity," Journal of Financial Economics, Elsevier, vol. 111(2), pages 381-405.
    9. Amy Finkelstein & Matthew Gentzkow & Heidi Williams, 2016. "Sources of Geographic Variation in Health Care: Evidence From PatientMigration," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 131(4), pages 1681-1726.
    10. David Molitor, 2018. "The Evolution of Physician Practice Styles: Evidence from Cardiologist Migration," American Economic Journal: Economic Policy, American Economic Association, vol. 10(1), pages 326-356, February.
    11. Jeffrey Clemens & Joshua D. Gottlieb, 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," American Economic Review, American Economic Association, vol. 104(4), pages 1320-1349, April.
    12. Currie, Janet & MacLeod, W. Bentley & Van Parys, Jessica, 2016. "Provider practice style and patient health outcomes: The case of heart attacks," Journal of Health Economics, Elsevier, vol. 47(C), pages 64-80.
    13. Jason Abaluck & Mauricio Caceres Bravo & Peter Hull: & Amanda Starc, 2021. "Mortality Effects and Choice Across Private Health Insurance Plans," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1557-1610.
    14. David C. Chan Jr & Matthew Gentzkow & Chuan Yu, 2019. "Selection with Variation in Diagnostic Skill: Evidence from Radiologists," NBER Working Papers 26467, National Bureau of Economic Research, Inc.
    15. Kenneth J. Arrow, 1975. "Vertical Integration and Communication," Bell Journal of Economics, The RAND Corporation, vol. 6(1), pages 173-183, Spring.
    16. Ricardo Alonso & Wouter Dessein & Niko Matouschek, 2008. "When Does Coordination Require Centralization?," American Economic Review, American Economic Association, vol. 98(1), pages 145-179, March.
    17. Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), 2011. "Handbook of Health Economics," Handbook of Health Economics, Elsevier, volume 2, number 2.
    18. Randall D. Cebul & James B. Rebitzer & Lowell J. Taylor & Mark E. Votruba, 2008. "Organizational Fragmentation and Care Quality in the U.S. Healthcare System," Journal of Economic Perspectives, American Economic Association, vol. 22(4), pages 93-113, Fall.
    19. Francine Lafontaine & Margaret Slade, 2007. "Vertical Integration and Firm Boundaries: The Evidence," Journal of Economic Literature, American Economic Association, vol. 45(3), pages 629-685, September.
    20. Agha, Leila & Frandsen, Brigham & Rebitzer, James B., 2019. "Fragmented division of labor and healthcare costs: Evidence from moves across regions," Journal of Public Economics, Elsevier, vol. 169(C), pages 144-159.
    21. Janet Currie & W. Bentley MacLeod, 2017. "Diagnosing Expertise: Human Capital, Decision Making, and Performance among Physicians," Journal of Labor Economics, University of Chicago Press, vol. 35(1), pages 1-43.
    22. Chris Forman & Anne Gron, 2011. "Vertical Integration and Information Technology Investment in the Insurance Industry," The Journal of Law, Economics, and Organization, Oxford University Press, vol. 27(1), pages 180-218.
    23. Michael Frakes, 2013. "The Impact of Medical Liability Standards on Regional Variations in Physician Behavior: Evidence from the Adoption of National-Standard Rules," American Economic Review, American Economic Association, vol. 103(1), pages 257-276, February.
    24. Lamar Pierce, 2012. "Organizational Structure and the Limits of Knowledge Sharing: Incentive Conflict and Agency in Car Leasing," Management Science, INFORMS, vol. 58(6), pages 1106-1121, June.
    25. Guido Friebel & Michael Raith, 2010. "Resource Allocation and Organizational Form," American Economic Journal: Microeconomics, American Economic Association, vol. 2(2), pages 1-33, May.
    26. Laurence C. Baker & M. Kate Bundorf & Daniel P. Kessler, 2020. "Does Multispecialty Practice Enhance Physician Market Power?," American Journal of Health Economics, University of Chicago Press, vol. 6(3), pages 324-347.
    27. Laurence C. Baker & M. Kate Bundorf & Anne Royalty, 2016. "Measuring Physician Practice Competition Using Medicare Data," NBER Chapters, in: Measuring and Modeling Health Care Costs, pages 351-377, National Bureau of Economic Research, Inc.
    28. Sendhil Mullainathan & David Scharfstein, 2001. "Do Firm Boundaries Matter?," American Economic Review, American Economic Association, vol. 91(2), pages 195-199, May.
    29. Ricardo Alonso & Wouter Dessein & Niko Matouschek, 2008. "When Does Coordination Require Centralization? Corrigendum," American Economic Review, American Economic Association, vol. 98(3), pages 1195-1196, June.
    30. Gautam Gowrisankaran & Keith A. Joiner & Pierre-Thomas Léger, 2017. "Physician Practice Style and Healthcare Costs: Evidence from Emergency Departments," NBER Working Papers 24155, National Bureau of Economic Research, Inc.
    31. Oliver Hart & Bengt Holmstrom, 2010. "A Theory of Firm Scope," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 125(2), pages 483-513.
    32. Silke J. Forbes & Mara Lederman, 2010. "Does vertical integration affect firm performance? Evidence from the airline industry," RAND Journal of Economics, RAND Corporation, vol. 41(4), pages 765-790, December.
    33. David Cutler & Jonathan S. Skinner & Ariel Dora Stern & David Wennberg, 2019. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 192-221, February.
    34. Thomas G. Koch & Brett W. Wendling & Nathan E. Wilson, 2021. "The Effects of Physician and Hospital Integration on Medicare Beneficiaries' Health Outcomes," The Review of Economics and Statistics, MIT Press, vol. 103(4), pages 725-739, October.
    35. Johannes Stroebel, 2016. "Asymmetric Information about Collateral Values," Journal of Finance, American Finance Association, vol. 71(3), pages 1071-1112, June.
    36. Robert S. Huckman & Gary P. Pisano, 2006. "The Firm Specificity of Individual Performance: Evidence from Cardiac Surgery," Management Science, INFORMS, vol. 52(4), pages 473-488, April.
    37. Skinner, Jonathan, 2011. "Causes and Consequences of Regional Variations in Health Care," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 45-93, Elsevier.
    38. Koch, Thomas G. & Wendling, Brett W. & Wilson, Nathan E., 2017. "How vertical integration affects the quantity and cost of care for Medicare beneficiaries," Journal of Health Economics, Elsevier, vol. 52(C), pages 19-32.
    39. Capps, Cory & Dranove, David & Ody, Christopher, 2018. "The effect of hospital acquisitions of physician practices on prices and spending," Journal of Health Economics, Elsevier, vol. 59(C), pages 139-152.
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    Cited by:

    1. Ari Bronsoler & Joseph Doyle & John Van Reenen, 2021. "The impact of healthcare IT on clinical quality, productivity and workers," CEP Discussion Papers dp1801, Centre for Economic Performance, LSE.
    2. Leila Agha & Keith Marzilli Ericson & Kimberley H. Geissler & James B. Rebitzer, 2022. "Team Relationships and Performance: Evidence from Healthcare Referral Networks," Management Science, INFORMS, vol. 68(5), pages 3735-3754, May.
    3. Joseph J. Doyle Jr. & Becky Staiger, 2021. "Physician Group Influences on Treatment Intensity and Health: Evidence from Physician Switchers," NBER Working Papers 29613, National Bureau of Economic Research, Inc.

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    More about this item

    JEL classification:

    • D23 - Microeconomics - - Production and Organizations - - - Organizational Behavior; Transaction Costs; Property Rights
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • L14 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Transactional Relationships; Contracts and Reputation

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