| 来源类型 | Working Paper |
| 规范类型 | 报告 |
| DOI | 10.3386/w28305 |
| 来源ID | Working Paper 28305 |
| Vertical Integration of Healthcare Providers Increases Self-Referrals and Can Reduce Downstream Competition: The Case of Hospital-Owned Skilled Nursing Facilities | |
| David M. Cutler; Leemore Dafny; David C. Grabowski; Steven Lee; Christopher Ody | |
| 发表日期 | 2021-01-04 |
| 出版年 | 2021 |
| 语种 | 英语 |
| 摘要 | The landscape of the U.S. healthcare industry is changing dramatically as healthcare providers expand both within and across markets. While federal antitrust agencies have mounted several challenges to same-market combinations, they have not challenged any non-horizontal affiliations – including vertical integration of providers along the value chain of production. The Clayton Act prohibits combinations that “substantially lessen” competition; few empirical studies have focused on whether this is the source of harm from vertical combinations. We examine whether hospitals that are vertically integrated with skilled nursing facilities (SNFs) lessen competition among SNFs by foreclosing rival SNFs from access to the most lucrative referrals. Exploiting a plausibly exogenous shock to Medicare reimbursement for SNFs, we find that a 1 percent increase in a patient’s expected profitability to a SNF increases the probability that a hospital self-refers that patient (i.e., to a co-owned SNF) by 2.5 percent. We find no evidence that increased self-referrals improve patient outcomes or change post-discharge Medicare spending. Additional analyses show that when integrated SNFs are divested by their parent hospitals, independent rivals are less likely to exit. Together, the results suggest vertical integration in this setting may reduce downstream competition without offsetting benefits to patients or payers. |
| 主题 | Health, Education, and Welfare ; Health ; Industrial Organization ; Firm Behavior ; Antitrust |
| URL | https://www.nber.org/papers/w28305 |
| 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/585978 |
| 推荐引用方式 GB/T 7714 | David M. Cutler,Leemore Dafny,David C. Grabowski,et al. Vertical Integration of Healthcare Providers Increases Self-Referrals and Can Reduce Downstream Competition: The Case of Hospital-Owned Skilled Nursing Facilities. 2021. |
| 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 | ||
| w28305.pdf（1375KB） | 智库出版物 | 限制开放 | CC BY-NC-SA | 浏览 | ||
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