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Hospital Market Structure and the Behavior of Not-For-Profit Hospitals

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  • Mark Duggan

Abstract

I exploit a change in hospital financial incentives to examine whether the behavior of private not-for-profit hospitals is systematically related to the share of nearby hospitals organized as for-profit firms. My findings demonstrate that not-for-profit hospitals in for-profit intensive areas are significantly more responsive to the change than their counterparts in areas served by few for-profit providers. Differences in financial constraints and other observable factors correlated with for-profit hospital penetration do not explain the heterogeneous response. The findings suggest that not-for-profit hospitals mimic the behavior of private for-profit providers when they actively compete with them.

Suggested Citation

  • 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.
  • Handle: RePEc:rje:randje:v:33:y:2002:i:autumn:p:433-446
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    Cited by:

    1. Nicholas Bloom & Carol Propper & Stephan Seiler & John Van Reenen, 2015. "The Impact of Competition on Management Quality: Evidence from Public Hospitals," Review of Economic Studies, Oxford University Press, vol. 82(2), pages 457-489.
    2. Karen Eggleston & Yu-Chu Shen & Joseph Lau & Christopher H. Schmid & Jia Chan, 2008. "Hospital ownership and quality of care: what explains the different results in the literature?," Health Economics, John Wiley & Sons, Ltd., vol. 17(12), pages 1345-1362.
    3. Alexandre Marinho, 2004. "Evidências e Modelos Sobre a Coexistência de Hospitais com Fins Lucrativos e Hospitais sem Fins Lucrativos no Sistema Único de Saúde Brasileiro," Discussion Papers 1041, Instituto de Pesquisa Econômica Aplicada - IPEA.
    4. Susan F. Lu, 2016. "The Role of Donations in Quality Disclosure: Evidence from Nonprofit Nursing Homes Full Access," American Journal of Health Economics, MIT Press, vol. 2(4), pages 431-462, Fall.
    5. Grabowski, David C. & Feng, Zhanlian & Hirth, Richard & Rahman, Momotazur & Mor, Vincent, 2013. "Effect of nursing home ownership on the quality of post-acute care: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 32(1), pages 12-21.
    6. Robert C. Seamans, 2012. "Fighting City Hall: Entry Deterrence and Technology Upgrades in Cable TV Markets," Management Science, INFORMS, vol. 58(3), pages 461-475, March.
    7. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    8. Carine Milcent, 2016. "Upcoding and heterogeneity in hospitals’ response: A Natural Experiment," Working Papers halshs-01340557, HAL.
    9. Dalton, Christina Marsh & Warren, Patrick L., 2016. "Cost versus control: Understanding ownership through outsourcing in hospitals," Journal of Health Economics, Elsevier, vol. 48(C), pages 1-15.
    10. Sujoy Chakravarty & Martin Gaynor & Steven Klepper & William B. Vogt, 2006. "Does the profit motive make Jack nimble? Ownership form and the evolution of the US hospital industry," Health Economics, John Wiley & Sons, Ltd., vol. 15(4), pages 345-361.
    11. Yu-Chu Shen & Karen Eggleston & Joseph Lau & Christopher Schmid, 2005. "Hospital Ownership and Financial Performance: A Quantitative Research Review," NBER Working Papers 11662, National Bureau of Economic Research, Inc.
    12. Jürges, Hendrik & Köberlein, Juliane, 2013. "First do no harm. Then do not cheat: DRG upcoding in German neonatology," MEA discussion paper series 201307, Munich Center for the Economics of Aging (MEA) at the Max Planck Institute for Social Law and Social Policy.
    13. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, Elsevier.
    14. Dalton, Christina Marsh & Warren, Patrick L., 2014. "Outsourcing Intensity and Ownership: Theory and Evidence from California General Care Hospitals," MPRA Paper 61949, University Library of Munich, Germany.
    15. Capps, Cory & Dranove, David & Lindrooth, Richard C., 2010. "Hospital closure and economic efficiency," Journal of Health Economics, Elsevier, vol. 29(1), pages 87-109, January.
    16. Biorn, Erik & Hagen, Terje P. & Iversen, Tor & Magnussen, Jon, 2006. "Heterogeneity in Hospitals' Responses to a Financial Reform: A Random Coefficient Analysis of The Impact of Activity-Based Financing on Efficiency," MPRA Paper 8169, University Library of Munich, Germany.
    17. Hendrik Jürges & Juliane Köberlein, 2013. "First Do No Harm. Then Do Not Cheat: DRG Upcoding in German Neonatology," CESifo Working Paper Series 4341, CESifo Group Munich.
    18. Leemore Dafny & Subramaniam Ramanarayanan, 2012. "Does it Matter if Your Health Insurer is For-Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending," NBER Working Papers 18286, National Bureau of Economic Research, Inc.
    19. Leemore S. Dafny, 2003. "How Do Hospitals Respond to Price Changes?," NBER Working Papers 9972, National Bureau of Economic Research, Inc.
    20. Abe Dunn & Adam Hale Shapiro, 2014. "Do Physicians Possess Market Power?," Journal of Law and Economics, University of Chicago Press, vol. 57(1), pages 159-193.
    21. Chau, Nancy H. & Huysentruyt, Marieke, 2006. "Nonprofits and public good provision: A contest based on compromises," European Economic Review, Elsevier, vol. 50(8), pages 1909-1935, November.
    22. Cory Capps & Dennis W. Carlton & Guy David, 2017. "Antitrust Treatment of Nonprofits: Should Hospitals Receive Special Care?," NBER Working Papers 23131, National Bureau of Economic Research, Inc.
    23. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters,in: Economics of Means-Tested Transfer Programs in the United States, volume 1, pages 21-136 National Bureau of Economic Research, Inc.
    24. Leemore S. Dafny, 2005. "How Do Hospitals Respond to Price Changes?," American Economic Review, American Economic Association, vol. 95(5), pages 1525-1547, December.
    25. Craig Garthwaite & Tal Gross & Matthew J. Notowidigdo, 2015. "Hospitals as Insurers of Last Resort," NBER Working Papers 21290, National Bureau of Economic Research, Inc.

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