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Abstract

To analyze the determinants and effects of hospital entry, we compare entrants’ quality of care to incumbent hospitals. Using national hospital-level patient mortality measures from July 2005 to June 2019 for Medicare patients with common medical conditions (heart attack, heart failure, and pneumonia), we establish that entrant hospitals experience 0.27 to 0.76 fewer deaths per 100 patients than incumbent hospitals in the same markets. We further show that new hospitals enter markets where they can provide higher quality care than incumbent hospitals.

Keywords

competition quality entry Medicare mortality

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References

Abraham

J. M.

Gaynor

Vogt a

. (2007). Entry and competition in local hospital markets. The Journal of Industrial Economics, 55(2), 265–288.

Aghion

Bechtold

Cassar

Herz

(2018). The causal effects of competition on innovation: Experimental evidence. The Journal of Law, Economics, and Organization, 34(2), 162–195.

Aghion

Blundell

Griffith

Howitt

Prantl

(2009). The effects of entry on incumbent innovation and productivity. The Review of Economics and Statistics, 91(1), 20–32.

American Health Planning Association. (2013). National directory: State certificate of need programs, health planning agencies (1994-2013). Annual volumes. http://www.ahpanet.org/national_directory.html

Arrow

(1963). Uncertainty and the welfare economics of medical care. American Economic Review, 53(5), 941–973.

Bartelsman

Haltiwanger

Scarpetta

(2013). Cross-country differences in productivity: The role of allocation and selection. American Economic Review, 103(1), 305–334.

Bresnahan

T. F.

Reiss

P. C.

(1991). Entry and competition in concentrated markets. Journal of Political Economy, 99(5), 997–1009.

Centers for Medicare & Medicaid Services. (2007). CMS 30-day hospital mortality measures. https://www.cms.gov/newsroom/fact-sheets/cms-30-day-hospital-mortality-measures

Centers for Medicare & Medicaid Services. (2016). Hospital compare. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare

10.

Centers for Medicare & Medicaid Services. (2018). Measure methodology reports: Mortality measures. QualityNet. https://qualitynet.cms.gov/inpatient/measures/mortality/methodology

11.

Chandra

Finkelstein

Sacarny

Syverson

(2016). Health care exceptionalism? Performance and allocation in the US health care sector. American Economic Review, 106(8), 2110–2144.

12.

Cooper

Craig

S. V.

Gaynor

Reenen

J. V.

(2019). The price ain’t right? Hospital prices and health spending on the privately insured. The Quarterly Journal of Economics, 134(1), 51–107.

13.

Dartmouth Atlas Project. (2019). The Dartmouth Atlast of Care. https://www.dartmouthatlas.org/

14.

Djellal

Gallouj

(2007). Innovation in hospitals: A survey of the literature. The European Journal of Health Economics, 8, 181–193.

15.

Ellis

R. P.

Martins

Zhu

(2017). Health care demand elasticities by type of service. Journal of Health Economics, 55, 232–243.

16.

Foster

Haltiwanger

J. C.

Krizan

C. J.

(2001). Aggregate productivity growth: Lessons from microeconomic evidence. In Hulten

C. R.

Dean

E. R.

Harper

M. J.

(Eds.), New developments in productivity analysis (pp. 303–372). University of Chicago Press.

17.

Foster

Haltiwanger

J. C.

Syverson

(2008). Reallocation, firm turnover, and efficiency: Selection on productivity or profitability. American Economic Review, 98(1), 394–425.

18.

Garnick

D. W.

Luft

H. S.

Robinson

J. C.

Tetreault

(1987). Appropriate measures of hospital market areas. Health Services Research, 1, 69–89.

19.

Gaynor

(2007). Competition and quality in health care markets. Foundations and Trends in Microeconomics, 2(6), 441–508.

20.

Gaynor

Moreno-Serra

Propper

(2013). Death by market power: Reform, competition, and patient outcomes in the National Health Service. American Economic Journal: Economic Policy, 5(4), 134–166.

21.

Hackmann

M. B.

(2019). Incentivizing better quality of care: The role of Medicaid and competition in the nursing home industry. American Economic Review, 109(5), 1684–1716.

22.

Han

Lee

K.-H.

(2021). The impact of public reporting schemes and market competition on hospital efficiency. Healthcare, 9(8), 1031. https://doi.org/10.3390/healthcare9081031

23.

Holmes

T. A.

Schmitz

J. A.

Jr. (1990). A theory of entrepreneurship and its application to the study of business transfers. Journal of Political Economy, 98(2), 265–294.

24.

Joynt

K. E.

Orav

E. J.

Jha

A. K.

(2011). Thirty-day readmission rates for Medicare beneficiaries by race and site of care. Journal of the American Medical Association, 305(7), 675–681.

25.

Kessler

D. P.

McClellan

M. B.

(1999). Is hospital competition socially wasteful? (No. w7266). National Bureau of Economic Research.

26.

Laudicella

Donni

P. L.

Smith

P. C.

(2013). Hospital readmission rates: Signal of failure or success? Journal of Health Economics, 32(5), 909–921.

27.

Lewis

M. S.

Pflum

K. E.

(2017). Hospital systems and bargaining power: Evidence from out-of-market acquisitions. The RAND Journal of Economics, 48(3), 579–610.

28.

Mankiw

N. G.

Whinston

M. D.

(1986). Free entry and social inefficiency. The RAND Journal of Economics, 17, 48–58.

29.

National Federation of Independent Businesses v. Sebelius, 132 S.Ct. 2566 (Supreme Court of the United States June 2012).

30.

Peretto

P. F.

(1999). Cost reduction, entry, and the interdependence of market structure and economic growth. Journal of Monetary Economics, 43(1), 173–195.

31.

Pope

G. C.

(1989). Hospital nonprice competition and Medicare reimbursement policy. Journal of Health Economics, 8(2), 147–172.

32.

Press

M. J.

Scanlon

D. P.

Ryan

A. M.

Zhu

Navathe

A. S.

Mittler

J. N.

Volpp

K. G.

(2013). Limits of readmission rates in measuring hospital quality suggest the need for added metrics. Health Affairs, 32(6), 1083–1091.

33.

QualityNet. (2020). HVBP measures. https://qualitynet.cms.gov/inpatient/hvbp/measures

34.

Robinson

J. C.

Luft

H. S.

(1985). The impact of hospital market structure on patient volume, average length of stay, and the cost of care. Journal of Health Economics, 4(4), 333–356.

35.

Schumpeter

(1942). Creative destruction. In Schumpeter

(Ed.), Capitalism, socialism and democracy (p. 82–85). Harper and Row.

36.

Schwartz

Lopez

Rae

Neuman

(2020). What we know about provider consolidation. Kaiser Family Foundation. https://www.kff.org/health-costs/issue-brief/what-we-know-about-provider-consolidation/

37.

Shain

Roemer

M. I.

(1959). Hospital costs relate to the supply of beds. Journal of Occupational and Environmental Medicine, 9, 518.

38.

Shen

V. C.-Y.

Ward

W. J.

Jr. Chen

L.-K.

(2019). Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care. Archives of Gerontology and Geriatrics, 83, 263–270.

39.

Skinner

(2012). Causes and consequences of regional variations in health care. In Pauly

M. V.

Mcguire

T. G.

Barros

P. P.

(Eds.), Handbook of health economics (Vol. 2, pp. 45–93). North-Holland.

40.

Song

Saghafian

(2019). Do hospital closures improve the efficiency and quality of other hospitals? Harvard University.

41.

Tabarrok

(2013). Private education in India: A novel test of cream skimming. Contemporary Economic Policy, 31(1), 1–12.

42.

Texas v. US, 340 F. Supp. 3d 579 (N.D. Texas 2018).

43.

Trinh

H. Q.

Begun

J. W.

Luke

R. D.

(2008). Hospital service duplication: Evidence on the medical arms race. Health Care Management Review, 33(3), 192–202.

44.

Tung

E. L.

Bruch

J. D.

Chin

M. H.

Menconi

Peek

M. E.

Huang

E. S.

(2024). Associations of US hospital closure (2007-2018) with area socioeconomic disadvantage and racial/ethnic composition. Annals of Epidemiology, 92, 40–46.

45.

Woolhandler

Ariely

Himmelstein

D. U.

(2012). Why pay for performance may be incompatible with quality improvement. British Medical Journal, 345, Article e5015.

Hospital Entry Improves Quality: Evidence From Common Medical Conditions

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