The Effects of Hospital Consolidation on Hospital Financial Performance and the Potential Trade-Off of Osph Ital Consolidation for Society" (2014)
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The College of Wooster Libraries Open Works Senior Independent Study Theses 2014 The ffecE ts of Hospital Consolidation on Hospital Financial Performance and the Potential Trade-Off of Hospital Consolidation for Society Aaron W. McKee The College of Wooster, [email protected] Follow this and additional works at: https://openworks.wooster.edu/independentstudy Part of the Health Economics Commons Recommended Citation McKee, Aaron W., "The Effects of Hospital Consolidation on Hospital Financial Performance and the Potential Trade-Off of ospH ital Consolidation for Society" (2014). Senior Independent Study Theses. Paper 5895. https://openworks.wooster.edu/independentstudy/5895 This Senior Independent Study Thesis Exemplar is brought to you by Open Works, a service of The oC llege of Wooster Libraries. It has been accepted for inclusion in Senior Independent Study Theses by an authorized administrator of Open Works. For more information, please contact [email protected]. © Copyright 2014 Aaron W. McKee The Effects of Hospital Consolidation on Hospital Financial Performance and the Potential Trade-Off of Hospital Consolidation for Society By: Aaron W. McKee Submitted in Partial Fulfillment of the Requirements of Senior Independent Study for the Department of Business Economics at the College of Wooster Advised By Dr. John Sell Department of Business Economics March 24, 2014 Acknowledgments There are several people I would like to acknowledge for their support and encouragement in the creation of this study. The first is my advisor, Dr. John Sell, who has assisted me in creating this Independent Study for over a year now. Without the guidance and input of Dr. Sell, this process would not have been as fulfilling. I am grateful that I was able to directly work with someone of his caliber and I will certainly miss our weekly discussions when I have graduated from Wooster. Furthermore, I would like to thank Dr. Barb Burnell for bringing the topic of hospital consolidation to my attention and for her patience and support throughout my four years here at the College of Wooster. I appreciate all of her guidance in the process of creating this project and I know that I could fill this page with a list of things that she has done to make my stay at Wooster a truly rewarding experience. I would also like to acknowledge Bill Sheron and Scott Boyes, who are always willing to answer my questions and provide me with input related to the topic of this study. Both Bill and Scott have enhanced this project and I am very thankful for the opportunities they have given me over the past year. Finally, I would like to thank my family and friends for everything they have done to make this project happen. In particular, I would like to thank my mother and father for their encouragement and for allowing me to attend the College of Wooster. In addition, I would like to thank Matt Naticchia, Luke Koniarczyk, Liam Pender, and Christen Kelly for keeping me sane throughout this process. Abstract This study examines the impact of hospital consolidation on the financial performance of consolidating hospitals. In doing so, this study also addresses the potential trade-off of hospital consolidation for society between decreased competition and improved efficiency. Based on economic theory, we hypothesize that hospital consolidation leads to an improvement in hospital financial performance by decreasing competition, which allows consolidating hospitals to charge higher prices, and by increasing efficiency, which lowers the costs of providing a given level of services for consolidating hospitals. Furthermore, we hypothesize that consolidation produces a competition/efficiency trade-off for society, as illustrated by the Williamson Trade-Off Model. We empirically test these hypotheses by running random effects regressions for a financial performance, price, and average cost model. Our results indicate that financial performance does improve for consolidating hospitals following consolidation, but there does not appear to be a trade-off for society. In fact, we find evidence that consolidation increases prices, but leads to an insignificant change in hospital efficiency/costs. Table of Contents I. Introduction..............................................................................................................1 II. Theoretical Analysis.................................................................................................4 2.0 Introduction to the Theoretical Analysis..............................................................4 2.1 Competition..........................................................................................................4 2.2 Efficiency.............................................................................................................8 2.3 The Effect of Hospital Consolidation on Efficiency and Competition..............15 2.4 The Trade-Off of Hospital Consolidation for Society........................................21 2.5 Post-Consolidation Profit Maximization with Two Hospital Facilities.............25 2.6 Summary of the Competition and Efficiency Discussion..................................28 2.7 Control Variables................................................................................................28 2.7.1 The Quality of Hospital Services.........................................................28 2.7.2 Ownership Structure............................................................................31 2.7.3 Population Characteristics and Demographics....................................33 2.8 Conceptual Model and Conclusion to the Theory Section.................................35 III. Review of Empirical Literature............................................................................37 3.0 Introduction to the Literature Section................................................................37 3.1 Heather Radach Sprang, Richard J. Arnould, and Gloria J. Bazzoli (2009)......38 3.2 Robert A. Connor, Roger D. Feldman, and Bryan E. Dowd (1998)..................46 3.3 David Dranove and Richard Lindrooth (2003)..................................................54 3.4 David Dranove (1998)........................................................................................59 3.5 Teresa D. Harrison (2011)..................................................................................67 3.6 Conclusion to the Literature Section..................................................................74 IV. Model Specification................................................................................................75 4.0 Introduction to the Model Specification Section................................................75 4.1 Operationalized Variables and Data Sources.....................................................75 4.1.1 Operationalizing Hospital Financial Performance..............................76 4.1.2 Operationalizing Competition.............................................................77 4.1.3 Operationalizing Efficiency................................................................79 4.1.4 Operationalizing Quality.....................................................................81 4.1.5 Operationalizing Ownership Structure................................................82 4.1.6 Operationalizing Population Characteristics and Demographics........83 4.1.7 Sample of Hospitals............................................................................85 4.1.8 Summary of Operationalized Variables..............................................86 4.2 Operational Models............................................................................................87 4.2.1 The Initial Models...............................................................................87 4.2.2 Panel Data and Panel Regressions.......................................................90 4.2.3 Summary of the Operation Models Section........................................96 V. Empirical Results...................................................................................................97 5.0 Introduction and Summary Statistics.................................................................97 5.1 Results of the Cross-Sectional Regressions.......................................................98 5.2 Potential Econometric Problems in the Cross-Sectional Regressions..............104 5.3 Random Effects Regressions............................................................................107 5.3.1 Results for the Operating Margin Model..........................................108 5.3.2 Results for the Price and Average Cost Models................................111 5.4 Potential Econometric Problems in the Random Effects Regressions.............114 5.5 Adjusted Inpatient Days vs. Adjusted Admissions..........................................118 5.6 Summary of the Empirical Results Section......................................................119 VI. Conclusion.............................................................................................................121 VII. Bibliography.........................................................................................................124 VIII. Appendices............................................................................................................126 Appendix 1: Derivation of Profit Margin and Price Elasticity Relationship.........126 Appendix 2: Price and Average Cost OLS Regressions with Robust SEs............127 Appendix 3: Random Effects Regressions