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Using Difference in Differences to Estimate Damages in Healthcare Antitrust: A Case Study of Marshfield Clinic

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  • R. Forrest McCluer
  • Martha A. Starr

Abstract

In calculating damages in healthcare antitrust cases, the difference-in-differences (DID) approach provides a potentially valuable means of controlling for lawful factors that influence prices, such as case mix and quality of care, as distinct from price differentials due to unlawful behavior. After comparing DID to traditional methods of estimating damages, this paper uses DID to analyze data from a well-known case against Marshfield Clinic, a large multi-specialty group practice that was found to have illegally allocated markets for physician services in Central Wisconsin. Using a specification similar to what was used in the case, we find that illegal behavior accounted for about one-half of the Clinic's extra increase in costs per patient during the damage period. The courts, however, were not persuaded that the analysis adequately controlled for legal factors. We discuss potential pitfalls in using DID to estimate damages suggested by the case, as well as possible ways around them .

Suggested Citation

  • R. Forrest McCluer & Martha A. Starr, 2013. "Using Difference in Differences to Estimate Damages in Healthcare Antitrust: A Case Study of Marshfield Clinic," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 20(3), pages 447-469, November.
    • Handle: RePEc:taf:ijecbs:v:20:y:2013:i:3:p:447-469
    DOI: 10.1080/13571516.2013.800323
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    1. Richard A. Posner, 1999. "The Law and Economics of the Economic Expert Witness," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 91-99, Spring.
    2. Leemore Dafny, 2009. "Estimation and Identification of Merger Effects: An Application to Hospital Mergers," Journal of Law and Economics, University of Chicago Press, vol. 52(3), pages 523-550, August.
    3. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 499-637, Elsevier.
    4. Joshua D. Angrist & Jörn-Steffen Pischke, 2010. "The Credibility Revolution in Empirical Economics: How Better Research Design Is Taking the Con out of Econometrics," Journal of Economic Perspectives, American Economic Association, vol. 24(2), pages 3-30, Spring.
    5. Joseph Farrell & Paul Pautler & Michael Vita, 2009. "Economics at the FTC: Retrospective Merger Analysis with a Focus on Hospitals," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 35(4), pages 369-385, December.
    6. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    7. 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.
    8. Justine S. Hastings, 2004. "Vertical Relationships and Competition in Retail Gasoline Markets: Empirical Evidence from Contract Changes in Southern California," American Economic Review, American Economic Association, vol. 94(1), pages 317-328, March.
    9. Gautam Gowrisankaran, 2011. "Estimating the Impact of a Hospital Merger Using the Difference-in-Differences of Prices," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 18(1), pages 83-89.
    10. Gregory Leonard & G. Steven Olley, 2011. "What Can Be Learned About the Competitive Effects of Mergers from "Natural Experiments"?," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 18(1), pages 103-107.
    11. Laporte, Audrey & Windmeijer, Frank, 2005. "Estimation of panel data models with binary indicators when treatment effects are not constant over time," Economics Letters, Elsevier, vol. 88(3), pages 389-396, September.
    12. Daniel L. Rubinfeld, 2010. "Econometric Issues in Antitrust Analysis," Journal of Institutional and Theoretical Economics (JITE), Mohr Siebeck, Tübingen, vol. 166(1), pages 62-77, March.
    13. Guido W. Imbens & Jeffrey M. Wooldridge, 2009. "Recent Developments in the Econometrics of Program Evaluation," Journal of Economic Literature, American Economic Association, vol. 47(1), pages 5-86, March.
    14. Christopher Garmon & Deborah Haas-Wilson, 2011. "The Use of Multiple Control Groups and Data Sources as Validation in Retrospective Studies of Hospital Mergers," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 18(1), pages 41-44.
    15. Gaynor, Martin, 2006. "Is vertical integration anticompetitive?: Definitely maybe (but that's not final)," Journal of Health Economics, Elsevier, vol. 25(1), pages 175-180, January.
    16. Cameron,A. Colin & Trivedi,Pravin K., 2005. "Microeconometrics," Cambridge Books, Cambridge University Press, number 9780521848053, October.
    17. Michael R. Baye & Joshua D. Wright, 2011. "Is Antitrust Too Complicated for Generalist Judges? The Impact of Economic Complexity and Judicial Training on Appeals," Journal of Law and Economics, University of Chicago Press, vol. 54(1), pages 1-24.
    18. Martha A. Starr & Forrest R. McCluer, 2014. "Prices and Quantities in Health Care Antitrust Damages," Working Papers 2014-03, American University, Department of Economics.
    19. Gregory Adams & Monica Noether, 2011. "Comment on "Hospital Mergers and Competitive Effects: Two Retrospective Analyses"," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 18(1), pages 33-40.
    20. Deborah Haas-Wilson & Christopher Garmon, 2011. "Hospital Mergers and Competitive Effects: Two Retrospective Analyses," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 18(1), pages 17-32.
    21. Steven Tenn, 2011. "The Price Effects of Hospital Mergers: A Case Study of the Sutter-Summit Transaction," International Journal of the Economics of Business, Taylor & Francis Journals, vol. 18(1), pages 65-82.
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    1. Martha A. Starr & Forrest R. McCluer, 2014. "Prices and Quantities in Health Care Antitrust Damages," Working Papers 2014-03, American University, Department of Economics.

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