Applying conventional horizontal merger enforcement rules to nonpro¢t hospitals is controversial. Critics contend that the di¡erent objective function of not-for-pro¢ts entities should mitigate competitive concerns about mergers involving nonpro¢t hospitals. We analyze a merger that reduced the number of competitors (both nonpro¢t) in the alleged relevant market from three to two. We ¢nd that the transaction was followed by signi¢cant price increases; we reject the hypothesis that these price increases re£ect higher postmerger quality. This study should help policymakers assess the validity of current merger enforcement rules, especially as they apply to notfor-pro¢t enterprises.
In this paper we examine the standard product market relied on by the courts and antitrust agencies in hospital mergers-acute care, inpatient services-and consider whether narrower or broader alternatives may be more appropriate to assess the competitive effects of a hospital merger. To examine how much disaggregation of the standard product market definition may matter for the definition of relevant geographic markets and concentration, we considered patient flows and concentration for the overall inpatient 'cluster' and more disaggregated categories of service for two regions of California: San Luis Obispo and Sacramento. We find that a disaggregated approach may involve a relatively small number of inpatient service categories, that the overall cluster masked some variability in the underlying patient flows by service category, and that in San Luis Obispo, the overall cluster masked considerable detail in concentration at the service category level, which appeared to have been much less true in Sacramento.Antitrust, Hospitals, Healthcare, Market Definition,
This paper estimates the incidence of local taxes and expenditures and the distribution of income in metropolitan Washington, DC, under our current fragmented system of governing metropolitan areas and under a hypothetical metropolitan-wide regime. The purpose of this exercise is to consider how the distribution of metropolitan resources might differ had society evolved toward a unified form of metropolitan governance . It is found that tax and expenditure incidence and the distribution of income are strikingly similar under both systems . From an equity perspective, neither the current fragmented system nor a unified system emerges as a clearly superior form of metropolitan organisation.
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