Economic Issues in the Antitrust Assessment of Hospital Competition: Overview

Rapid consolidation in the hospital industry, as health care markets respond to consumer pressures for more cost-effective delivery of health care services, has focused increased attention on antitrust enforcement theories and actions. This paper reviews the Federal agency challenges of four recent hospital mergers that have all been denied by the courts, but for varying reasons. Questions raised include the appropriate definition of the product and geographic markets, the extent of realizable merger-specific efficiencies and the influence of non-profit status on hospital behavior. The lack of conclusive empirical economic evidence on these topics undoubtedly contributes to the current divergence of opinion among regulators, courts and hospitals. This paper also identifies how each of the subsequent papers in this special issue contributes valuable findings to inform the lively debate.     

Expert Report in United States v. Interstate Bakeries Corp. and Continental Baking Co.

This is a condensed antitrust analysis of the proposed merger of two leading bakers of white pan bread. The traditional structural analysis is supplemented by merger simulation, which estimates the likely price effects of the merger.     

Effect of R&D and Market Concentration on Merger Outcomes – An Event Study of US Horizontal Mergers

This study examines the pattern of abnormal returns for merging companies and rivals, to determine investor expectations regarding the impact of horizontal mergers challenged by the government. Prior studies have indicated that the government may have challenged efficiency-enhancing mergers, as evidenced by the pattern of abnormal returns to rivals during merger events. This study uses a two-stage regression approach to examine those patterns, using challenged mergers from 1997 to 2007, and finds evidence of potential price effects from approved mergers. The results also show the mergers to have differential effects depending on the level of R&D, market concentration, and product sales.     

Predicting the Price Effect of Mergers with Polynomial Logit Demand

We propose a polynomial logit model to quantify the price effects of mergers in a static Nash setting. The proposed model is parsimonious in parameters and is shown to have excellent predictive power, rivaling the in-sample and out-of-sample predictive accuracy of the widely-used AIDS model.The analysis, using actual scanner data on bread sales, demonstrates that a linear logit model is likely to over-estimate the merger price effect.     

Spatial Interaction,Spatial Multipliers and Hospital Competition

The hospital competition literature shows that estimates of the effect of local market structure (concentration) on pricing (competition) are sensitive to geographic market definition. Our spatial lag model approach effects smoothing of the explanatory variables across the discrete market boundaries, resulting in robust estimates of the impact of market structure on hospital pricing, which can be used to estimate the full effect of changes in prices inclusive of spillovers that cascade through the neighboring hospital markets. The full amount, generated by the spatial multiplier effect, is a robust estimate of the impacts of market factors on hospital competition. We contrast ordinary least squares and spatial lag estimates to demonstrate the importance of robust estimation in analysis of hospital market competition. In markets where concentration is relatively high before a proposed merger, we demonstrate that Ordinary Least Squares (OLS) can lead to the wrong policy conclusion while the more conservative lag estimates do not.     

Simulating Partial Asset Divestitures to 'Fix' Mergers

In this paper, we apply and extend merger simulation methodology to analyze the effectiveness of partial divestitures as a 'fix' to remedy the possible anticompetitive effects of horizontal mergers. Typically, antitrust agencies require merging firms to divest assets so that the status quo before the merger is restored, that is, they favor a 'full divestiture'. We focus on the effectiveness of a partial divestiture as an antitrust remedy (where a subset of products owned by the merging firms is spun off). Although this is not the type of full divestiture favored by antitrust agencies, we argue here that a partial divestiture could leave consumers better off after the merger than they were before - under certain conditions. Using a real-world example, we show how divesting a relatively close substitute creates competition that offsets the anticompetitive effects of combining products that are relatively distant substitutes. This result stands even when the divestee is moderately inefficient.     

An Introduction to the Symposium on the Use of Simulation in Applied Industrial Organization

Simulation offers a rigorous methodology for addressing policy or litigation issues that require a comparison of an observed state of the world with an unobserved one. Simulation employs a calibrated, structural oligopoly model to describe the unobserved state of the world. Calibration involves reliance on real-world observations to set the key parameter values in the model. Simulation is an increasingly important tool of the industrial organization economist, particularly in analyzing the competitive effects of mergers. Papers in this symposium illustrate merger simulations in a variety of contexts and one other application of simulation.     

Competition in the Pharmaceutical Industry: The Case of PAH Drugs

The nature and extent of competition between different therapies for a given medical condition often is an important and controversial issue in both antitrust cases and general strategic analysis in the pharmaceutical industry. The market for pulmonary arterial hypertension (‘PAH’) therapies provides an interesting case study for analyzing these issues. An event study analyzing how the stock prices of PAH therapy providers respond to competitive developments in the industry sheds light on the nature of competition among different types of therapies. The results support the view that the strength of competition between any two drugs for the same condition can vary greatly depending on factors such as the stage of the patient’s disease, the mode of drug delivery, the mechanism of action, convenience/ease of use and other characteristics.     

全球交易所的竞争:市场结构的变化

本文运用国际金融市场特别是期货市场的统计数据和案例材料,从横向竞争、纵向竞争、会员资格的开放和会员的多样化、竞争的资本密集程度的提高这几个方面,总结了交易所面临的竞争挑战.对美国占全球期货市场份额变化的分析表明,传统金融市场强国逐步丧失了绝对的垄断地位.但全球期货期权交易市场集中度的提高,却揭示了当前交易所服务市场竞争格局的复杂性.     

Supramonopoly: Theory and Evidence from the US Air Passenger Service Markets

A supramonopoly is the market structure of a homogeneous good that is priced higher than the monopoly level. We present evidence of supramonopoly in the US air passenger service. For four airline mergers during the period of 1993 to 2009, we identify routes that dropped fares for no other reason than the increase in market power due to merger. Therefore each of those routes had fare higher than the monopoly level before the merger to monopoly. We explain supramonopoly as the result of a cartel with strongly punitive matching rules. We also discuss the striking implications for antitrust and regulatory policies.     

Unrestricted Entry and Nonprice Competition: The Case of Technological Adoption in Hospitals

Medical technology adoption is a major contributor to rising health care expenditures in the US. Multiple market failures provide incentives for hospitals to adopt technologies. Unrestricted entry may result in excess capacity and reductions in output that are inefficient with respect to cost and quality. We analyze the effects of hospital entry in the market for coronary artery bypass graft surgery on the number of procedures performed at both the market and firm levels, using California data from 1983 to 1990. We test the hypothesis that entry has differential effects on hospital output in a market with nonprice competition, depending on market structure. Results show that as the proximity of the nearest competitor increases with entry, hospital output declines. Holding distance to the nearest competitor constant, increasing the number of competitors results in a smaller, but still significant, decrease in output. When there are few incumbents nearby, however, output does not change significantly with entry, suggesting "business-augmenting" effects that result in increased physician referrals offset much of the conventional "businessstealing" effects.     

Economics and Antitrust Enforcement: The Last 25 Years

Abstract

Economics has reshaped antitrust enforcement over the last quarter century. Its impact has been most dramatic in merger analysis, with the shift toward unilateral effects theories and away from market concentration-related theories of collusion. Progress on both the theoretical and empirical fronts has also changed enforcement priors and competitive analyses concerning vertical restraints and monopolization. Economists also have made valuable assessments of the effectiveness of antitrust enforcement, though more work in this area is needed.     

Are Patients Traveling Further?

Managed care has been hypothesized to increase patient travel for health care services by steering patients to more distant providers. This raises access concerns. However, if the result is to expand the geographic extent of provider markets, this may ease antitrust concerns about mergers. This research compares travel distances for patients discharged from California hospitals in 1985 and 1991 controlling for payor, diagnosis, and local market conditions. Privately insured patients were more likely to be in managed care than Medicare patients during this period. We expect travel distances to increase for private patients relative to Medicare patients if managed is leading to greater travel. However, for a random sample of patients excluding births and neonatal discharges, we find no evidence relative travel increased. Nor do we find a systematic pattern of increase when we examine travel for specific diagnoses selected on the basis of the urgency and complexity of care.     

Internal Versus External R&D: A Study of R&D Choice with Sample Selection

This paper extends previous analyses of the choice between internal and external R&D to consider the costs of internal R&D. The Heckman two-stage estimator is used to estimate the determinants of internal R&D unit cost (i.e. cost per product innovation) allowing for sample selection effects. Theory indicates that R&D unit cost will be influenced by scale issues and by the technological opportunities faced by the firm. Transaction costs encountered in research activities are allowed for and, in addition, consideration is given to issues of market structure which influence the choice of R&D mode without affecting the unit cost of internal or external R&D. The model is tested on data from a sample of over 500 UK manufacturing plants which have engaged in product innovation. The key determinants of R&D mode are the scale of plant and R&D input, and market structure conditions. In terms of the R&D cost equation, scale factors are again important and have a non-linear relationship with R&D unit cost. Specificities in physical and human capital also affect unit cost, but have no clear impact on the choice of R&D mode. There is no evidence of technological opportunity affecting either R&D cost or the internal/external decision.     

Evaluating wireless carrier consolidation using semiparametric demand estimation

The US mobile phone service industry has dramatically consolidated over the last two decades. One justification for consolidation is that merged firms can provide consumers with larger coverage areas at lower costs. We estimate the willingness to pay for national coverage to evaluate this justification for past consolidation. As market level quantity data are not publicly available, we devise an econometric procedure that allows us to estimate the willingness to pay using market share ranks collected from the popular online retailer Amazon. Our semiparametric maximum score estimator controls for consumers’ heterogeneous preferences for carriers, handsets and minutes of calling time. We find that national coverage is strongly valued by consumers, providing an efficiency justification for across-market mergers. The methods we propose can estimate demand for other products using data from online retailers where product ranks, but not quantities, are observed.