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Hospital Market Concentration and Discrimination of Patients

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  • Ralf Dewenter
  • Thomas Jaschinski
  • Björn A. Kuchinke

Abstract

In this paper we investigate the existence of a two-tier medical system in the German acute care hospital sector using data from a survey of 483 German hospitals. The focus of our analysis lies on the impact of hospital concentration on the probability of discrimination of patients with different health insurances in regard to the access to medical services. Accounting for a possible endogeneity of market structure, we find that hospitals in highly concentrated markets are less likely to pursue any differentiation among prospective patients with different health insurances. We ascribe this finding to competitive pressure in less concentrated markets. Hospitals in competitive markets are more obliged to steal business from rival hospitals by privileging profitable patients than hospitals in highly concentrated markets.

Suggested Citation

  • Ralf Dewenter & Thomas Jaschinski & Björn A. Kuchinke, 2013. "Hospital Market Concentration and Discrimination of Patients," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 133(3), pages 345-374.
    • Handle: RePEc:aeq:aeqsjb:v133_y2013_i3_q3_p345-374
    DOI: 10.3790/schm.133.3.345
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    1. Gaynor, Martin & Vogt, William B., 2000. "Antitrust and competition in health care markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 27, pages 1405-1487, Elsevier.
    2. Horwitz, Jill R. & Nichols, Austin, 2009. "Hospital ownership and medical services: Market mix, spillover effects, and nonprofit objectives," Journal of Health Economics, Elsevier, vol. 28(5), pages 924-937, September.
    3. Carol Propper & Simon Burgess & Denise Gossage, 2008. "Competition and Quality: Evidence from the NHS Internal Market 1991–9," Economic Journal, Royal Economic Society, vol. 118(525), pages 138-170, January.
    4. Motta,Massimo, 2004. "Competition Policy," Cambridge Books, Cambridge University Press, number 9780521016919.
    5. Brekke, Kurt R. & Siciliani, Luigi & Straume, Odd Rune, 2008. "Competition and waiting times in hospital markets," Journal of Public Economics, Elsevier, vol. 92(7), pages 1607-1628, July.
    6. Kathleen Carey & James F. Burgess & Gary J. Young, 2011. "Hospital competition and financial performance: the effects of ambulatory surgery centers," Health Economics, John Wiley & Sons, Ltd., vol. 20(5), pages 571-581, May.
    7. Ryan Mutter & Patrick Romano & Herbert Wong, 2011. "The Effects of US Hospital Consolidations on Hospital Quality," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 18(1), pages 109-126.
    8. Andrews,Donald W. K. & Stock,James H. (ed.), 2005. "Identification and Inference for Econometric Models," Cambridge Books, Cambridge University Press, number 9780521844413.
    9. Tay, Abigail, 2003. "Assessing Competition in Hospital Care Markets: The Importance of Accounting for Quality Differentiation," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 786-814, Winter.
    10. Plotzke, Michael & Courtemanche, Charles, 2009. "Does Competition from Ambulatory Surgical Centers Affect Hospital Surgical Output and Hospital Profit?," UNCG Economics Working Papers 09-6, University of North Carolina at Greensboro, Department of Economics.
    11. Robinson, James C. & Luft, Harold S., 1985. "The impact of hospital market structure on patient volume, average length of stay, and the cost of care," Journal of Health Economics, Elsevier, vol. 4(4), pages 333-356, December.
    12. Siciliani, Luigi & Hurst, Jeremy, 2005. "Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries," Health Policy, Elsevier, vol. 72(2), pages 201-215, May.
    13. Lee, Kwang-soo & Chun, Ki-hong & Lee, Jung-soo, 2008. "Reforming the hospital service structure to improve efficiency: Urban hospital specialization," Health Policy, Elsevier, vol. 87(1), pages 41-49, July.
    14. Gaynor, Martin & Vogt, William B, 2003. "Competition among Hospitals," RAND Journal of Economics, The RAND Corporation, vol. 34(4), pages 764-785, Winter.
    15. Luigi Siciliani & Steve Martin, 2007. "An empirical analysis of the impact of choice on waiting times," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 763-779, August.
    16. Courtemanche, Charles & Plotzke, Michael, 2010. "Does competition from ambulatory surgical centers affect hospital surgical output?," Journal of Health Economics, Elsevier, vol. 29(5), pages 765-773, September.
    17. Carol Propper & Jenny Eachus & Philip Chan & Nicky Pearson & George Davey Smith, 2005. "Access to health care resources in the UK: the case of care for arthritis," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 391-406, April.
    18. Christoph Schwierz & Achim Wübker & Ansgar Wübker & Björn Kuchinke, 2011. "Discrimination in waiting times by insurance type and financial soundness of German acute care hospitals," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(5), pages 405-416, October.
    19. Moulton, Brent R, 1990. "An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit," The Review of Economics and Statistics, MIT Press, vol. 72(2), pages 334-338, May.
    20. Edward C. Norton & Douglas O. Staiger, 1994. "How Hospital Ownership Affects Access to Care for the Uninsured," RAND Journal of Economics, The RAND Corporation, vol. 25(1), pages 171-185, Spring.
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    More about this item

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • L1 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance
    • L19 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Other
    • L22 - Industrial Organization - - Firm Objectives, Organization, and Behavior - - - Firm Organization and Market Structure

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