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Competition or Coordination in Hospital Markets with Unionised Labour


  • Kurt R. Brekke



This paper study labour market responses to hospital mergers. The market consists of two hospitals providing horizontally and vertically differentiated services. Hospitals compete either in price and quality or just in quality (non-price competition). To provide medical care, hospitals employ health care workers (e.g., physicians, nurses). The workers collectively bargain wages either at a central level, firm level or plant level. Anticipating wage responses, hospitals decide whether or not to merge. The main finding is that the bargaining structure, the nature of competition and the patient copayment rate have a crucial impact on the profitability of hospital mergers.

Suggested Citation

  • Kurt R. Brekke, 2004. "Competition or Coordination in Hospital Markets with Unionised Labour," International Journal of Health Economics and Management, Springer, vol. 4(1), pages 65-89, March.
  • Handle: RePEc:kap:ijhcfe:v:4:y:2004:i:1:p:65-89

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    References listed on IDEAS

    1. Christopher F Baum & Mark E. Schaffer & Steven Stillman, 2003. "Instrumental variables and GMM: Estimation and testing," Stata Journal, StataCorp LP, vol. 3(1), pages 1-31, March.
    2. Eckerlund, Ingemar & Gerdtham, Ulf-G, 1996. "Variation in cesarean section rates in Sweden - Causes and economic consequences," SSE/EFI Working Paper Series in Economics and Finance 106, Stockholm School of Economics.
    3. Danzon, Patricia M., 2000. "Liability for medical malpractice," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 26, pages 1339-1404 Elsevier.
    4. Epstein, Andrew J. & Nicholson, Sean, 2009. "The formation and evolution of physician treatment styles: An application to cesarean sections," Journal of Health Economics, Elsevier, vol. 28(6), pages 1126-1140, December.
    5. D. Fabbri & C. Monfardini & R. Radice, 2004. "Testing exogeneity in the bivariate probit model: Monte Carlo evidence and an application to health economics," Working Papers 514, Dipartimento Scienze Economiche, Universita' di Bologna.
    6. D. Fabbri & C. Monfardini, 2001. "Demand Induction with a Discrete Distribution of Patients," Working Papers 414, Dipartimento Scienze Economiche, Universita' di Bologna.
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    Cited by:

    1. Luciano Fanti & Nicola Meccheri, 2016. "Non-Rigid Wages And Merger Profitability Reversal Under Convex Costs And Centralized Unionization," Bulletin of Economic Research, Wiley Blackwell, vol. 68(4), pages 383-395, October.
    2. Nicola Meccheri & Luciano Fanti, 2012. "Managerial Delegation Schemes in a Duopoly with Endogenous Production Costs: A Comparison of Sales and Relative Profit Delegation under Centralised Unionisation," Working Paper series 44_12, Rimini Centre for Economic Analysis.
    3. Luciano Fanti & Nicola Meccheri, 2014. "Capacity choice and welfare under alternative unionisation structures," Discussion Papers 2014/176, Dipartimento di Economia e Management (DEM), University of Pisa, Pisa, Italy.
    4. Luciano Fanti & Nicola Meccheri, 2013. "Managerial Delegation under Alternative Unionization Structures," LABOUR, CEIS, vol. 27(1), pages 38-57, March.
    5. Kurt R. Brekke & Luigi Siciliani & Odd Rune Straume, "undated". "Horizontal Mergers and Product Quality," NIPE Working Papers 07/2014, NIPE - Universidade do Minho.
    6. Luciano Fanti & Nicola Meccheri, 2012. "Merger results under price competition and plant-specific unions," Discussion Papers 2012/135, Dipartimento di Economia e Management (DEM), University of Pisa, Pisa, Italy.
    7. repec:bla:manchs:v:85:y:2017:i:6:p:661-681 is not listed on IDEAS
    8. Luciano Fanti & Nicola Meccheri, 2012. "Differentiated Duopoly and Horizontal Merger Profitability under Monopoly Central Union and Convex Costs," Working Paper series 05_12, Rimini Centre for Economic Analysis.
    9. Fanti, Luciano & Meccheri, Nicola, 2014. "Profits and competition under alternative technologies in a unionized duopoly with product differentiation," Research in Economics, Elsevier, vol. 68(2), pages 157-168.
    10. Herr, Annika, 2009. "Product differentiation and welfare in a mixed duopoly with regulated prices: the case of a public and a private hospital," FAU Discussion Papers in Economics 08/2009, Friedrich-Alexander University Erlangen-Nuremberg, Institute for Economics.
    11. Luciano Fanti & Nicola Meccheri, 2012. "Price competition, merger and welfare under firm-specific unions: on the role of unions’ preference towards wages," Discussion Papers 2012/136, Dipartimento di Economia e Management (DEM), University of Pisa, Pisa, Italy.
    12. repec:nip:nipewp:10/2014 is not listed on IDEAS
    13. Nicola Meccheri & Luciano Fanti, 2016. "Should delegation contracts be made before or after union wage setting? Endogenous moves in a managerial-unionized duopoly," Working Paper series 16-18, Rimini Centre for Economic Analysis.
    14. Annika Herr, 2011. "Quality and Welfare in a Mixed Duopoly with Regulated Prices: The Case of a Public and a Private Hospital," German Economic Review, Verein für Socialpolitik, vol. 12(4), pages 422-437, November.
    15. Kurt R. Brekke & Luigi Siciliani & Odd Rune Straume, 2017. "Hospital Mergers with Regulated Prices," Scandinavian Journal of Economics, Wiley Blackwell, vol. 119(3), pages 597-627, July.
    16. Kurt R. Brekke & Lars Sørgard, 2007. "Public versus private health care in a national health service," Health Economics, John Wiley & Sons, Ltd., vol. 16(6), pages 579-601.

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