The Impact of Competition on Investment: Evidence From California Hospitals*

I examine the relationship between bargaining leverage and capital investment using data on California’s hospital markets. I find evidence that investment increases with bargaining leverage; a hospital whose bargaining position improves by one standard deviation will increase its investment rate by 16 percentage points. A positive causal relationship between bargaining leverage and investment fits the institutional details of the health care sector, where many firms have non-profit tax status, making it difficult to return monopoly rents to shareholders. Consistent with this explanation, I find that non-profit hospitals with bargaining leverage invest more than for-profit ones, all else equal. I do not find strong evidence that financing constraints matter disproportionately for hospitals operating in more competitive markets, supporting the hypothesis that the incremental investment may not be socially efficient.