Geographic Markets in Hospital Mergers: a Case Study
Geographic Markets in Hospital Mergers: a Case Study

Author: Federal Trade Federal Trade Commission

Publisher: CreateSpace

Published: 2014-09-13

Total Pages: 26

ISBN-13: 9781502355119

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In three recent hospital merger cases, the courts concluded that the merged hospital would be unable to increase price profitably because of competition from distant hospitals. In reaching this conclusion, the courts found the following: hospitals earn high margins on the last patients that they serve; given these high margins, a small price increase would be unprofitable if even a relatively small percentage of patients switched to other hospitals; many of the merging hospitals' patients live in "contestable" zip codes, where a large percentage of patients already use other hospitals; a price increase at the merging hospitals would prompt a large number of these patients to switch to other hospitals; and this amount of switching would make the price increase unprofitable. This book argues that the courts in these cases erred in accepting the defendants' argument that switching by patients living in "contestable" zip codes would make a price increase at the merging hospitals unprofitable. Specifically, this book examines the behavior of patients following a merger similar to those analyzed by these courts and finds that a large price increase prompted little switching by patients living in "contestable" zip codes.

Health Care Mergers and Acquisitions Handbook
Health Care Mergers and Acquisitions Handbook

Author:

Publisher: American Bar Association

Published: 2003

Total Pages: 222

ISBN-13: 9781590312230

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The health care industry continues to undergo unprecedented consolidation. Health care providers and payors alike have pursued a wide variety of integrative strategies to achieve efficiencies or other business advantages. The Health Care Mergers and Acquisitions Handbook is designed to educate the practitioner about the antitrust analysis of mergers and acquisitions within the health care industry. Over the past two decades there has been an extraordinary amount of litigation related to challenges of hospital mergers. Each chapter identifies and analyzes important antitrust issues governing such consolidations. Accordingly, the first several chapters are devoted to a detailed treatment of substantive issues peculiar to such mergers: an introduction to hospital merger litigation, describing trends in litigation and the way in which such mergers are analyzed; issues unique to market definition, including product market definition and geographic market definition; the competitive effects of hospital mergers, assessing the evidence necessary to establish a prima facie case in a merger challenge and the rebuttal arguments offered by merging parties; a unique rebuttal argument offered by merging hospitals that is treated separately due to its prominent role in hospital merger litigation - the role and significance of efficiencies in determining the competitive merits of such mergers; the potential applicability of the state action doctrine to hospital mergers. In addition to a substantive treatment of hospital mergers, the Handbook also addresses; combinations of health care management organizations (HMOs) and physician practice groups; the analysis used by the enforcement agencies when reviewing mergers of HMOs; antitrust issues posed by physician practice consolidations. The appendix contains a chart summarizing litigated hospital mergers.--

The Competitive Effects of Not-For-Profit Hospital Mergers
The Competitive Effects of Not-For-Profit Hospital Mergers

Author: Federal Trade Commission

Publisher: CreateSpace

Published: 2014-09-14

Total Pages: 48

ISBN-13: 9781502365576

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Applying conventional horizontal merger enforcement rules to mergers of nonprofit hospitals is controversial. Critics contend that the different objective function of not-for-profits entities should mitigate, and possibly eliminate, competitive concerns about mergers involving nonprofit hospitals. We provide evidence relevant to this debate by analyzing ex post a horizontal merger in a concentrated hospital market. Here, the transaction reduced the number of competitors (both nonprofit) in the alleged relevant market from three to two. We find that the transaction resulted in significant price increases; we reject the hypothesis that these price increases reflect higher post-merger quality. This study should help policymakers assess the validity of current merger enforcement rules, especially as they apply to not-for-profit enterprises.

Getting Market Definition Right
Getting Market Definition Right

Author: Martin Gaynor

Publisher:

Published: 2017

Total Pages: 9

ISBN-13:

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In 2016 the Federal Trade Commission (“FTC”) lost motions for preliminary injunction in two separate hospital mergers. In both cases the district courts rejected the FTC's geographic market definition based on flawed interpretations of the “hypothetical monopolist” test. Fortunately, the appeals courts correctly identified the district courts' errors and reversed their decisions. In this article, we review the process used by the FTC and the Antitrust Division of the Department of Justice to define markets and discuss how this process applies to the markets for hospital services specifically. We summarize the courts' opinions in these two hospital merger cases and discuss the ways in which the district courts erred in their analyses and how the appeals courts' decisions will affect future merger cases.

A Structural Approach to Market Definition With an Application to the Hospital Industry
A Structural Approach to Market Definition With an Application to the Hospital Industry

Author: Martin Gaynor

Publisher:

Published: 2011

Total Pages: 50

ISBN-13:

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Abstract: Market definition is essential to merger analysis. Because no standard approach to market definition exists, opposing parties in antitrust cases often disagree about the extent of the market. These differences have been particularly relevant in the hospital industry, where the courts have denied seven of eight merger challenges since 1994, due largely to disagreements over geographic market definition. We compare geographic markets produced using common ad hoc methodologies to a method that directly applies the â??SSNIP testâ?? to hospitals in California using a structural model. Our results suggest that previously employed methods overstate hospital demand elasticities by a factor of 2.4 to 3.4 and define larger markets than would be implied by the merger guidelines's hypothetical monopolist test. The use of these methods in differentiated product industries may lead to mistaken geographic market delineation, and was likely a contributing factor to the permissive legal environment for hospital mergers

The Price Effects of Hospital Mergers
The Price Effects of Hospital Mergers

Author: Federal Trade Commission

Publisher:

Published: 2014-09-25

Total Pages: 30

ISBN-13: 9781502493859

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This consummated merger combined two hospitals located close together in the Oakland-Berkeley region of the San Francisco Bay Area. The greater metropolitan area contained many other hospitals that offered a similar range of services, but which were located farther away. A central issue raised by the Sutter-Summit transaction was whether travel costs were low enough such that these hospitals were a sufficient constraint on the merging parties to prevent an anticompetitive price increase. We use detailed claims data from three large health insurers to compare the post-merger price change for the merging parties to the price change for a set of control group hospitals. Our results show that Summit's price increase was among the largest of any comparable hospital in California, indicating this transaction may have been anticompetitive.