| 来源类型 | Working Paper |
| 规范类型 | 报告 |
| DOI | 10.3386/w22826 |
| 来源ID | Working Paper 22826 |
| Hospital Competition, Quality, and Expenditures in the U.S. Medicare Population | |
| Carrie Colla; Julie Bynum; Andrea Austin; Jonathan Skinner | |
| 发表日期 | 2016-11-14 |
| 出版年 | 2016 |
| 语种 | 英语 |
| 摘要 | Theoretical models of competition with fixed prices suggest that hospitals should compete by increasing quality of care for diseases with the greatest profitability and demand elasticity. Most empirical evidence regarding hospital competition is limited to heart attacks, which in the U.S. generate positive profit margins but exhibit very low demand elasticity – ambulances usually take patients to the closest (or affiliated) hospital. In this paper, we derive a theoretically appropriate measure of market concentration in a fixed-price model, and use differential travel-time to hospitals in each of the 306 U.S. regional hospital markets to instrument for market concentration. We then estimate the model using risk-adjusted Medicare data for several different population cohorts: heart attacks (low demand elasticity), hip and knee replacements (high demand elasticity) and dementia patients (low demand elasticity, low or negative profitability). First, we find little correlation within hospitals across quality measures. And second, while we replicate the standard result that greater competition leads to higher quality in some (but not all) measures of heart attack quality, we find essentially no association between competition and quality for what should be the most competitive markets – elective hip and knee replacements. Consistent with the model, competition is associated with lower quality care among dementia patients, suggesting that competition could induce hospitals to discourage unprofitable patients. |
| 主题 | Health, Education, and Welfare ; Health ; Industrial Organization ; Nonprofits ; Antitrust |
| URL | https://www.nber.org/papers/w22826 |
| 来源智库 | National Bureau of Economic Research (United States) |
| 引用统计 | |
| 资源类型 | 智库出版物 |
| 条目标识符 | http://119.78.100.153/handle/2XGU8XDN/580500 |
| 推荐引用方式 GB/T 7714 | Carrie Colla,Julie Bynum,Andrea Austin,et al. Hospital Competition, Quality, and Expenditures in the U.S. Medicare Population. 2016. |
| 条目包含的文件 | ||||||
| 文件名称/大小 | 资源类型 | 版本类型 | 开放类型 | 使用许可 | ||
| w22826.pdf（514KB） | 智库出版物 | 限制开放 | CC BY-NC-SA | 浏览 | ||
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