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Input Constraints and the Efficiency of Entry: Lessons from Cardiac Surgery

Author

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  • David M. Cutler

    () (Harvard University)

  • Robert S. Huckman

    () (Harvard Business School, Technology and Operations Management Unit)

  • Jonathan T. Kolstad

    () (The Wharton School, University of Pennsylvania)

Abstract

Prior studies suggest that, with elastically supplied inputs, free entry may lead to an inefficiently high number of firms in equilibrium. Under input scarcity, however, the welfare loss from free entry is reduced. Further, free entry may increase use of high-quality inputs, as oligopolistic firms underuse these inputs when entry is constrained. We assess these predictions by examining how the 1996 repeal of certificate-of-need (CON) legislation in Pennsylvania affected the market for cardiac surgery in the state. We show that entry led to a redistribution of surgeries to higher-quality surgeons and that this entry was approximately welfare neutral.

Suggested Citation

  • David M. Cutler & Robert S. Huckman & Jonathan T. Kolstad, 2009. "Input Constraints and the Efficiency of Entry: Lessons from Cardiac Surgery," Harvard Business School Working Papers 10-011, Harvard Business School.
  • Handle: RePEc:hbs:wpaper:10-011
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    References listed on IDEAS

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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. Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
    3. Averett, Susan L. & Terrizzi, Sabrina & Wang, Yang, 2017. "Taking the CON out of Pennsylvania: Did Hip and Knee Replacement Patients Benefit?," IZA Discussion Papers 10917, Institute for the Study of Labor (IZA).
    4. Zack Cooper & Stephen Gibbons & Simon Jones & Alistair McGuire, 2012. "Does Competition Improve Public Hospitals' Efficiency? Evidence from a Quasi-Experiment in the English National Health Service," CEP Discussion Papers dp1125, Centre for Economic Performance, LSE.
    5. Lamar Pierce & Jason Snyder, 2015. "Unethical Demand and Employee Turnover," Journal of Business Ethics, Springer, vol. 131(4), pages 853-869, November.
    6. Jill R. Horwitz & Daniel Polsky, 2015. "Cross Border Effects of State Health Technology Regulation," American Journal of Health Economics, MIT Press, vol. 1(1), pages 101-123, Winter.
    7. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, pages 235-284.
    8. Suhui Li & Avi Dor, 2013. "How Do Hospitals Respond to Market Entry? Evidence from A Deregulated Market for Cardiac Revascularization," NBER Working Papers 18926, National Bureau of Economic Research, Inc.
    9. Cooper, Zack & Gibbons, Stephen & Skellern, Matthew, 2016. "Does competition from private surgical centres improve public hospitals’ performance? Evidence from the English National Health Service," LSE Research Online Documents on Economics 67662, London School of Economics and Political Science, LSE Library.
    10. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, Elsevier.
    11. Chou, Shin-Yi & Deily, Mary E. & Li, Suhui & Lu, Yi, 2014. "Competition and the impact of online hospital report cards," Journal of Health Economics, Elsevier, vol. 34(C), pages 42-58.
    12. Lamar Pierce & Michael W. Toffel, 2010. "The Role of Organizational Scope and Governance in Strengthening Private Monitoring," Harvard Business School Working Papers 11-004, Harvard Business School, revised Feb 2012.
    13. Jill R. Horwitz & Daniel Polsky, 2014. "Cross Border Effects of State Health Technology Regulation," NBER Working Papers 19801, National Bureau of Economic Research, Inc.
    14. In Kyung Kim & Yoon-Jin Lee & Young-Ro Yoon, 2017. "Sequential Supply Decision and Market Efficiency: Theory and Evidence," Working Papers 1703, Nazarbayev University, Department of Economics, revised Mar 2017.
    15. Jonathan T. Kolstad, 2013. "Information and Quality When Motivation Is Intrinsic: Evidence from Surgeon Report Cards," American Economic Review, American Economic Association, vol. 103(7), pages 2875-2910, December.
    16. Alfons Palangkaraya & Jongsay Yong, 2013. "Effects of competition on hospital quality: an examination using hospital administrative data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 415-429, June.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • L13 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Oligopoly and Other Imperfect Markets

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