Hospital Ownership Mix Efficiency in the US: An Exploratory Study

This paper offers an empirical test of ownership mix efficiency in the U.S. hospital services industry. The test compares the benefits of quality assurance with the costs from the attenuation of property rights that result from an increased presence of nonprofit organizations. The empirical results suggest that too many not-for-profit and public hospitals may exist in the typical market area of the U.S. The policy implication is that more quality of care per dollar might be obtained by attracting a greater percentage of for-profit hospitals into some market areas. This conclusion, however, is tempered with several caveats. We discuss these and also make recommendations for further research.

Testing for Ownership Mix Efficiency: The Case of the Nursing Home Industry

This paper offers an empirical test of ownership mix efficiency in the U.S. nursing home industry. We test to compare the benefits of quality assurance with the costs from the attenuation of property rights that result from an increased presence of nonprofit organizations. The empirical results suggest that too few nonprofit nursing homes may exist in the typical market area of the U.S. The policy implication is that more quality of care per dollar might be obtained by attracting a greater percentage of nonprofit nursing homes into most market areas.

Do Agglomeration Economies Exist in the Hospital Services Industry

Given the importance of knowledge flows and the continued emphasis on face-to-face encounters especially for medical care, close proximity of hospitals may be essential for the efficient delivery of medical care. That is, hospital productivity might be greater where hospitals cluster and allow knowledge to more easily and quickly disperse among personnel in the various organizations. To add to the understanding about agglomeration economies in the hospital services sector, this study analyzes how the clustering of hospitals in the various metropolitan areas of the US affects industry wide productivity. The multiple regression analysis is conducted on a cross-sectional basis for both 1993 and 1999 and by using first differencing of the data between the two years. The observed productivity improvements resulting from the clustering of hospitals provides yet another justification for encouraging a larger number of hospitals in metropolitan areas.

Jurisdiction Size and Director Compensation in Connecticut Local Health Departments

Objective: To examine if the compensation of local public health directors responds to organizational size in the same manner found for other types of for-profit, not-for-profit, and public managers. Design: Panel data ordinary least squares with fixed effects for the local health department and time period. Control variables include median household income, the unemployment rate, and the part-time versus full-time and independent versus district status of the local public health department. Setting: Sample of Connecticut local health departments over the period from 2001 to 2011. Main Outcome Measures: Annual wage of the local public health director and population in the jurisdiction of the local public health department. Results: The size elasticity of local public health director equals 0.2. Full-time directors are paid more than part-time directors and directors managing district health departments are compensated more than those directing independent health departments. Directors are paid more if they manage health departments in jurisdictions with higher levels of income. Conclusions: The findings for the size elasticity of compensation for local public health directors compares very closely to the size elasticity estimates found for other types of for-profit, not-for-profit, and public managers, perhaps suggesting that local public health directors are similarly motivated

Leviathan or Median-Voter: Who Runs City Hall?

This study examines the effect of interjurisdictional competition and city age, as a proxy for special interest group activities, on the size of city government. Unlike previous studies on the Leviathan theory, the empirical analysis is well grounded in a median-voter model. The empirical results find mixed support for a Leviathan in city hall. On the one hand, city expenditures are found to be higher rather than lower with more intense competition. On the other hand, longer periods of democratic stability, measured by uninterrupted years of incorporation as a city, are associated with increased public expenditures, as a Leviathan-type model predicts.Government; Interest Group; Voter

The Aggregate Demand for Private Health Insurance Coverage in the U.S.

This paper estimates the aggregate demand for private health insurance coverage in the U.S. using an error-correction model and by recognizing that people are without private health insurance for voluntary, structural, frictional, and cyclical reasons and because of public alternatives. Insurance coverage is measured both by the percentage of the population enrolled in private health insurance plans and the completeness of the insurance coverage. Annual data for the period 1966-1999 are used and both short and long run price and income elasticities of demand are estimated. The empirical findings indicate that both private insurance enrollment and completeness are relatively inelastic with respect to changes in price and income in the short and long run. Moreover, private health insurance enrollment is found to be inversely related to the poverty rate, particularly in the short-run. Finally, our results suggest that an increase in the number cyclically uninsured generates less of a welfare loss than an increase in the structurally uninsured

Hospital Market Structure and Cost Performance: A Case Study

Prior research on the nonprice theory of hospital competition uses data prior to the mid-1980s when third party payers were insensitive to hospital prices. Moreover, existing studies fail to test this theory for the different types of hospital ownership. In response to these issues, this research employs a more current data set and examines this theory for three distinct samples of nonprice theory of hospital competition only for nonprofit institutions. Conversely, costs for public and for-profit hospitals are found to be unaffected by market structure.Hospital; Hospitals; Market Structure