Market Structure, Employment, and Skill Mix in the Hospital Industry

Robinson, James C.

doi:10.2307/1059105

Cited by 45 publications

(30 citation statements)

References 17 publications

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“…Sloan and Elnicki (1978) and Feldman and Scheffler (1982) found hospital wage rates to be higher in competitive than in concentrated markets. Robinson (1988) found that hospitals in the most competitive local markets hire more registered nurses and more nonnurse personnel than otherwise comparable hospitals in less competitive markets. These hospitals substituted registered for licensed practical nurses more frequently than did hospitals in other market environments.…”

Section: Structural Measures Of Quality: the Role Of Signallingmentioning

confidence: 94%

Hospital Quality Competition and the Economics of Imperfect Information

Robinson¹

1988

The Milbank Quarterly

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TitleHospital quality competition and the economics of imperfect information ally focused on quality rather than price and, in particular, on the availability of medical technology. Price competition has been effectively discouraged by legal and professional barriers to selective contracting, and the dominance of structural measures of quality such as medical technology has been ensured by the paucity of process-and outcome-oriented quality indexes. The hospital environment has been changing rapidly in the past few years, however.Selective contracting on the basis of price is being pursued vigorously by many public and private purchasers of hospital services. Process and outcome measures of hospital performance are proliferating and are being widely disseminated. This has profound implications for the nature of hospital competition.Economic theory has made its primary contribution to health services research and policy based on its ability to transfer insights gained in the observation of other industries to the health care field. The textbook economic model of the competitive industry, in which well-informed consumers choose among a range of products based on price and quality, underlies much of the current research and policy interest in health care market performance. The emergence of selective contracting and outcome-oriented measures of quality would seem to strengthen this model's claim to being the appropriate analytic framework for studying the health care sector.

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Section: Structural Measures Of Quality: the Role Of Signallingmentioning

confidence: 94%

Hospital Quality Competition and the Economics of Imperfect Information

Robinson¹

1988

The Milbank Quarterly

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“…A negative relationship is taken as evidence of (presumptively welfare reducing) non-price competition. Indexes of input use often used are the presence of particular technologies , Luft et al, 1986, Robinson et al, 1987, length of stay (Robinson andLuft, 1985, Hersch, 1984), staffing levels and/or mixes (Robinson, 1988, Hersch, 1984, and reserve capacity (Joskow, 1980). A typical finding in this literature is that higher levels of concentration lead to lower levels of input use.…”

Section: Structure-conduct-performance: Non-pricementioning

confidence: 99%

Antitrust and Competition in Health Care Markets

Gaynor¹,

Vogt²

1999

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“…* According to the MAR hypothesis, hospitals compete by providing too many high-technology medical services and hiring excess staff. At the same time, unnecessary duplication of services may cause the quality of care to drop as providers fail to take advantage of the scale of learning effect9 (Robinson and Luft 1985;Robinson 1988;Hersch 1984;Luft et al 1986). Zwanziger and Melnick (1988) find evidence consistent with the MAR hypothesis and infer that, as a result, hospitals compete on quality instead of price.…”

Section: Previous Researchmentioning

confidence: 99%