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R J Arnould

Publications and source records attributed to R J Arnould.

10 recordsLinked to original sources
PubMed1995

Federal antitrust merger enforcement standards: a good fit for the hospital industry?

We examine the implications of the 1992 Horizontal Merger Guidelines for the hospital industry and subsequent policy statements that were developed for health care providers. Application of antitrust policy to hospitals has raised several concerns, mainly because many communities have few hospitals and economic forces in the industry are accelerating interest in intramarket mergers and provider network development. We address several issues, including the standing of hospitals relative to the market concentration thresholds of the merger guidelines, market concentration compared among challenged and unchallenged mergers of the 1980s, findings of previous research about the relationship between market concentration and competition in hospital markets, and differences in characteristics other than market concentration that are relevant to the merger guidelines among challenged and unchallenged mergers. We found that (1) the specific standards articulated in the merger guidelines do not provide good predictability of when a hospital merger challenge would occur, and (2) comparisons of challenged and unchallenged mergers in similarly structured markets suggest that enforcement actions may deviate in practice from the enforcement principles of the merger guidelines. We consider several options for refining antitrust enforcement policy. Refinement of enforcement policies is important given the industry restructuring that is likely through health care reform.

Antitrust Laws↗
PubMed1992

Utilization control in HMOs.

Health Maintenance Organizations (HMOs) have emerged as a major vehicle to reduce transaction costs associated with defining the limits of health insurance coverage and to provide appropriate provider incentives. This article explains the heterogeneous set of incentives used by HMOs to reimburse providers and performs empirical tests of their effectiveness. The empirical analyses reveal that utilization of health care services is reduced when (1) physician compensation is based on salary or capitation arrangements rather than some measure of output; (2) bonuses and paybacks are based on individual rather than group performance; and (3) when the HMO operates as a proprietary (for-profit) organization. Utilization is not significantly affected by incentives placed on the hospital. Finally, physician ownership of the HMO was found to lead to higher levels of utilization.

Capitation Fee↗
PubMed1990

The health care cost "problem".

This serves as an introduction to this special issue devoted to a selection of papers chosen and revised from a conference on public policy entitled "Health Care Policy: Where Is the Revolution Headed?" sponsored by the Thomas Jefferson Program in Public Policy at the College of William and Mary, Williamsburg, VA, November 12-14, 1987.

Cost Control↗
PubMed1990

The problem of attaining an efficient capital stock.

Serious problems exist with the nature of health care financing in the United States. This article summarizes problems caused by the high cost of serving an aging population, the lack of incentives in insurance plans for preventive care, and the growing number of uninsured people in the population. The article then focuses on efforts to bring about greater efficiency by changing the contractual relations between the principal--either the payor or the patient--and the agent--the provider. These new contracts attempt to place a greater share of the financial burden on the provider. Evidence of the success of these new contracts is mixed. The major point of the article is that real efficiencies will not be reached unless these incentive mechanisms together with competitive market forces relieve the excess capacity in the health care industry.

Aged↗
PubMed1985

The effect of provider control of Blue Shield plans on health care markets.

Blue Shield plans often are granted regulatory advantages by the states in which they operate. Run efficiently, such not-for-profit firms should use these lower costs to eliminate their less advantaged rivals, the commercial insurers. However, these higher-cost commercial providers have been able to offer insurance coverage at prices competitive with the Blues, as evidenced by the fact that Blue plans have, on average, less than 50 percent market share. Similar prices with lower overall costs implies that economic rents are being earned, rents which a not-for-profit firm cannot distribute to owners. In this paper we argue that when there are competing goals among the groups controlling the Blue Shield plans, the different possible "uses" of the regulatory advantage become endogenously determined, necessitating the use of simultaneous equation estimation. Testing this model we find the major effect of doctor-control of Blue Shield plans is to raise doctors' fees while lowering the amount of rents captured by both consumers and administrators.

Blue Cross Blue Shield Insurance Plans↗
PubMed1984

Do HMOs produce specific services more efficiently?

Previous research on the effects of HMOs on health care costs has concentrated on aggregate costs and resource use and has shown that HMOs result in lower costs. The only consistent sources of the cost savings are the lower hospital admission rates and hospital lengths of stay for HMO enrollees. This paper contains the results of an investigation of whether HMOs can more efficiently produce a given service. Four common inpatient procedures were analyzed to determine whether there were any differences in resource consumption and overall costs for HMO patients than for fee-for-service patients. Although significant levels of resource savings were found for various procedures for HMO enrollees, these savings did not always result in lower overall costs.

Cost Control↗
PubMedDate not supplied

Hospital mergers and savings for consumers: exploring new evidence.

This study analyzes changes in costs and prices from 1989 to 1997 for 1,767 short-term hospitals, including 204 hospitals involved in mergers; 653 hospitals that were rivals to these merging hospitals; and 910 nonmerging nonrival hospitals. We find that merging hospitals generally had lower growth in costs and prices compared with their rivals and also with nonmerging nonrival hospitals. We find that the presence and extent of these savings varied based on market and hospital conditions. However, our findings suggest that cost and price savings resulting from mergers may be smaller than estimated in earlier studies, especially through our comparison of merging hospitals with their rivals.

Efficiency, Organizational↗