Skip to main content
Health Services Research logoLink to Health Services Research
. 2001 Apr;36(1 Pt 2):223–251.

Measuring competition in health care markets.

L C Baker 1
PMCID: PMC1089203  PMID: 11327175

Abstract

OBJECTIVE: Measuring competition is increasingly important for analysis of health care markets and policies. Measurement of competition in health care is made complex by the breadth of potential issues under study, by the lack of necessary data, and by rapid changes in health care financing and delivery. This study reviews key issues in the measurement of competition and is designed to familiarize researchers and policymakers interested in competition measurement, but not steeped in its practice, with key concepts, data sources, and ways of adapting measures to fit ongoing changes in health care markets. PRINCIPAL FINDINGS: Attention to several key issues will strengthen measurement. Important components of successful measurement are: careful identification of the products and market areas for study; selection of Herfindahl-Hirschman or other indices to fit the issues being considered; consideration of econometric problems, like endogeneity, with common measures; and attention to the ways that current marketplace changes, like growth in managed care, affect the performance of classic measures. Data needed for constructing measures are also frequently scarce, insufficient, or both. Measurement could be improved with access to better data.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker L. C., Corts K. S. HMO penetration and the cost of health care: market discipline or market segmentation? Am Econ Rev. 1996 May;86(2):389–394. [PubMed] [Google Scholar]
  2. Baker L. C. The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare. J Health Econ. 1997 Aug;16(4):453–481. doi: 10.1016/s0167-6296(96)00535-8. [DOI] [PubMed] [Google Scholar]
  3. Bazzoli G. J., Shortell S. M., Dubbs N., Chan C., Kralovec P. A taxonomy of health networks and systems: bringing order out of chaos. Health Serv Res. 1999 Feb;33(6):1683–1717. [PMC free article] [PubMed] [Google Scholar]
  4. Bernstein A. B., Gauthier A. K. Defining competition in markets: why and how? Health Serv Res. 1998 Dec;33(5 Pt 2):1421–1438. [PMC free article] [PubMed] [Google Scholar]
  5. Burns L. R., Bazzoli G. J., Dynan L., Wholey D. R. Managed care, market stages, and integrated delivery systems: is there a relationship? Health Aff (Millwood) 1997 Nov-Dec;16(6):204–218. doi: 10.1377/hlthaff.16.6.204. [DOI] [PubMed] [Google Scholar]
  6. Dranove D., Shanley M., Simon C. Is hospital competition wasteful? Rand J Econ. 1992 Summer;23(2):247–262. [PubMed] [Google Scholar]
  7. Dranove D., Simon C. J., White W. D. Determinants of managed care penetration. J Health Econ. 1998 Dec;17(6):729–745. doi: 10.1016/s0167-6296(97)00045-3. [DOI] [PubMed] [Google Scholar]
  8. Dynan L., Bazzoli G. J., Burns R. Assessing the extent of integration achieved through physician-hospital arrangements. J Healthc Manag. 1998 May-Jun;43(3):242–262. [PubMed] [Google Scholar]
  9. Enthoven A., Kronick R. A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (1). N Engl J Med. 1989 Jan 5;320(1):29–37. doi: 10.1056/NEJM198901053200106. [DOI] [PubMed] [Google Scholar]
  10. Enthoven A., Kronick R. A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (2). N Engl J Med. 1989 Jan 12;320(2):94–101. doi: 10.1056/NEJM198901123200205. [DOI] [PubMed] [Google Scholar]
  11. Gaynor M., Haas-Wilson D. Change, consolidation, and competition in health care markets. J Econ Perspect. 1999 Winter;13(1):141–164. doi: 10.1257/jep.13.1.141. [DOI] [PubMed] [Google Scholar]
  12. Gruber J. The effect of competitive pressure on charity: hospital responses to price shopping in California. J Health Econ. 1994 Jul;13(2):183–212. doi: 10.1016/0167-6296(94)90023-x. [DOI] [PubMed] [Google Scholar]
  13. Haas-Wilson D., Gaynor M. Increasing consolidation in healthcare markets: what are the antitrust policy implications? Health Serv Res. 1998 Dec;33(5 Pt 2):1403–1419. [PMC free article] [PubMed] [Google Scholar]
  14. Japsen B. Another record year for dealmaking. Activity among medium-size companies fuels continued drive toward consolidation. Mod Healthc. 1996 Dec 23;26(52):37-8, 40-1, 44-6. [PubMed] [Google Scholar]
  15. Luft H. S., Robinson J. C., Garnick D. W., Maerki S. C., McPhee S. J. The role of specialized clinical services in competition among hospitals. Inquiry. 1986 Spring;23(1):83–94. [PubMed] [Google Scholar]
  16. Melnick G. A., Zwanziger J., Bamezai A., Pattison R. The effects of market structure and bargaining position on hospital prices. J Health Econ. 1992 Oct;11(3):217–233. doi: 10.1016/0167-6296(92)90001-h. [DOI] [PubMed] [Google Scholar]
  17. Noether M. Competition among hospitals. J Health Econ. 1988 Sep;7(3):259–284. doi: 10.1016/0167-6296(88)90028-8. [DOI] [PubMed] [Google Scholar]
  18. Pauly M. V. Managed care, market power, and monopsony. Health Serv Res. 1998 Dec;33(5 Pt 2):1439–1460. [PMC free article] [PubMed] [Google Scholar]
  19. Robinson J. C., Garnick D. W., McPhee S. J. Market and regulatory influences on the availability of coronary angioplasty and bypass surgery in U.S. hospitals. N Engl J Med. 1987 Jul 9;317(2):85–90. doi: 10.1056/NEJM198707093170205. [DOI] [PubMed] [Google Scholar]
  20. Robinson J. C., Luft H. S. The impact of hospital market structure on patient volume, average length of stay, and the cost of care. J Health Econ. 1985 Dec;4(4):333–356. doi: 10.1016/0167-6296(85)90012-8. [DOI] [PubMed] [Google Scholar]
  21. Robinson J. C., Phibbs C. S. An evaluation of Medicaid selective contracting in California. J Health Econ. 1989;8(4):437–455. doi: 10.1016/0167-6296(90)90025-x. [DOI] [PubMed] [Google Scholar]
  22. Simon C. J., Dranove D., White W. D. The effect of managed care on the incomes of primary care and specialty physicians. Health Serv Res. 1998 Aug;33(3 Pt 1):549–569. [PMC free article] [PubMed] [Google Scholar]
  23. Wholey D., Feldman R., Christianson J. B. The effect of market structure on HMO premiums. J Health Econ. 1995 May;14(1):81–105. doi: 10.1016/0167-6296(94)00039-7. [DOI] [PubMed] [Google Scholar]
  24. Zwanziger J., Melnick G. A. The effects of hospital competition and the Medicare PPS program on hospital cost behavior in California. J Health Econ. 1988 Dec;7(4):301–320. doi: 10.1016/0167-6296(88)90018-5. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES