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Market Power, Transactions Costs, and the Entry of Accountable Care Organizations in Health Care H. E. Frech III.1 • Christopher Whaley2 • Benjamin R. Handel3 • Liora Bowers4 • Carol J. Simon5 • Richard M. Scheffler6 Published online: 15 July 2015 � Springer Science+Business Media New York 2015 Abstract ACOs were promoted in the 2010 Patient Protection and Affordable Care Act (ACA) to incentivize integrated care and cost control. Because they involve vertical and horizontal collaboration, ACOs also have the potential to harm competition. In this paper, we analyze ACO entry and formation patterns with the use of a unique, proprietary database that includes public (Medicare) and private ACOs. We estimate an empirical model that explains county-level ACO entry as a function of: physician, hospital, and insurance market structure; demographics; and other economic and regulatory factors. We find that physician concentration by organization has little effect. In contrast, physician concentration by geographic Earlier versions of this paper were presented at the International Industrial Organization Conference in Boston, the International Health Economics Association meeting in Sydney, the Allied Social Science meetings in Philadelphia, the ACO Workshop in Berkeley, and the Bates White Health Care and Life Science Seminar in Washington, D.C. Thanks are due to the participants of those meetings, especially Martha Starr, Dean Rice, and Martin Gaynor for helpful comments. Thanks are also due to Sandra Decker, Abe Dunn, Robert Obstfeldt, Jim Rebitzer, Michael Morrisey, Jessica Foster, and Lee Mobley for helpful comments on earlier versions and to the referees and editor of this journal for more recent useful comments. & H. E. Frech III. [email protected] Christopher Whaley [email protected] Benjamin R. Handel [email protected] Liora Bowers [email protected] Carol J. Simon [email protected] 1 Department of Economics, University of California, Santa Barbara, Santa Barbara, CA 93106, USA 123 Rev Ind Organ (2015) 47:167–193 DOI 10.1007/s11151-015-9467-y http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf http://crossmark.crossref.org/dialog/?doi=10.1007/s11151-015-9467-y&domain=pdf site—which is a new measure of locational concentration of physicians—discour- ages ACO entry. Hospital concentration generally has a negative effect. HMO penetration is a strong predictor of ACO entry, while physician-hospital organiza- tions have little effect. Small markets discourage entry, which suggests economies of scale for ACOs. Predictors of public and private ACO entry are different. State regulations of nursing and the corporate practice of medicine have little effect. Keywords Health care competition � Antitrust � Entry � Integration � Accountable care organizations � Transactions costs � Obama plan JEL Classification L 14 � I11 � L44 � I18 � L41 1 Introduction and Overview The US health car ...
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DQ 3-2 Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system. Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources. Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system. Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf Dq 3-1 1. In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
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Skills of introducing the lesson presents by Mrs. Amanpreet Kaur, Assistant Professor Khalsa College of Education, G.T. Road Amritsar
SKILL OF INTRODUCING THE LESSON MICRO SKILLS.pptx
SKILL OF INTRODUCING THE LESSON MICRO SKILLS.pptx
Amanpreet Kaur
cultivation of kodo Millet ppt #kodomillet
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
pradhanghanshyam7136
Basic Civil Engineering notes first year Notes Building notes Selection of site for Building Layout of a Building What is Burjis, Mutam Building Bye laws Basic Concept of sunlight ventilation in building National Building Code of India Set back or building line Types of Buildings Floor Space Index (F.S.I) Institutional Vs Educational Building Components & function Sills, Lintels, Cantilever Doors, Windows and Ventilators Types of Foundation AND THEIR USES Plinth Area Shallow and Deep Foundation Super Built-up & carpet area Floor Area Ratio (F.A.R) RCC Reinforced Cement Concrete RCC VS PCC
Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
Denish Jangid
How Bosna and Herzegovina prepares for CBAM
Key note speaker Neum_Admir Softic_ENG.pdf
Key note speaker Neum_Admir Softic_ENG.pdf
Admir Softic
Brief to be read ahead of the Student Project Simulation event.
Spatium Project Simulation student brief
Spatium Project Simulation student brief
Association for Project Management
https://app.box.com/s/7hlvjxjalkrik7fb082xx3jk7xd7liz3
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
Nguyen Thanh Tu Collection
Spell
Spellings Wk 3 English CAPS CARES Please Practise
Spellings Wk 3 English CAPS CARES Please Practise
AnaAcapella
The pricing and discounting feature is very essential for Odoo POS. Global discount is actually a discount that will apply to the entire order. And it indicates that the discount is applied to every item in the order, regardless of how much each item costs separately. This slide will show how to manage global discounts in odoo 17 POS.
How to Manage Global Discount in Odoo 17 POS
How to Manage Global Discount in Odoo 17 POS
Celine George
national learning camp 2024
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
MaritesTamaniVerdade
The slides are based on a workshop with practical advice and tools on supporting learners with dyslexia using generative AI.
Dyslexia AI Workshop for Slideshare.pptx
Dyslexia AI Workshop for Slideshare.pptx
callscotland1987
SGK
1029 - Danh muc Sach Giao Khoa 10 . pdf
1029 - Danh muc Sach Giao Khoa 10 . pdf
QucHHunhnh
https://medicaleducationelearning.blogspot.com/2024/02/using-micro-scholarship-to-incentivize.html
Micro-Scholarship, What it is, How can it help me.pdf
Micro-Scholarship, What it is, How can it help me.pdf
Poh-Sun Goh
In this webinar, members learned the ABCs of keeping books for a nonprofit organization. Some of the key takeaways were: - What is accounting and how does it work? - How do you read a financial statement? - What are the three things that nonprofits are required to track? -And more
Introduction to Nonprofit Accounting: The Basics
Introduction to Nonprofit Accounting: The Basics
TechSoup
Group presentation on verbal communication
Magic bus Group work1and 2 (Team 3).pptx
Magic bus Group work1and 2 (Team 3).pptx
dhanalakshmis0310
AAPI Month Slide Deck
Asian American Pacific Islander Month DDSD 2024.pptx
Asian American Pacific Islander Month DDSD 2024.pptx
David Douglas School District
Students will get the knowledge of the following: - meaning of Pharmaceutical sales representative (PSR) - purpose of detailing, training & supervision - norms of customer calls - motivating, evaluating, compensation and future aspects of PSR
Unit-IV; Professional Sales Representative (PSR).pptx
Unit-IV; Professional Sales Representative (PSR).pptx
VishalSingh1417
Pie
The basics of sentences session 3pptx.pptx
The basics of sentences session 3pptx.pptx
heathfieldcps1
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ICT role in 21st century education and it's challenges.
ICT role in 21st century education and it's challenges.
Third Battle of Panipat detailed notes.pptx
Third Battle of Panipat detailed notes.pptx
Grant Readiness 101 TechSoup and Remy Consulting
Grant Readiness 101 TechSoup and Remy Consulting
SKILL OF INTRODUCING THE LESSON MICRO SKILLS.pptx
SKILL OF INTRODUCING THE LESSON MICRO SKILLS.pptx
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
Kodo Millet PPT made by Ghanshyam bairwa college of Agriculture kumher bhara...
Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
Basic Civil Engineering first year Notes- Chapter 4 Building.pptx
Key note speaker Neum_Admir Softic_ENG.pdf
Key note speaker Neum_Admir Softic_ENG.pdf
Spatium Project Simulation student brief
Spatium Project Simulation student brief
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
TỔNG ÔN TẬP THI VÀO LỚP 10 MÔN TIẾNG ANH NĂM HỌC 2023 - 2024 CÓ ĐÁP ÁN (NGỮ Â...
Spellings Wk 3 English CAPS CARES Please Practise
Spellings Wk 3 English CAPS CARES Please Practise
How to Manage Global Discount in Odoo 17 POS
How to Manage Global Discount in Odoo 17 POS
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
2024-NATIONAL-LEARNING-CAMP-AND-OTHER.pptx
Dyslexia AI Workshop for Slideshare.pptx
Dyslexia AI Workshop for Slideshare.pptx
1029 - Danh muc Sach Giao Khoa 10 . pdf
1029 - Danh muc Sach Giao Khoa 10 . pdf
Micro-Scholarship, What it is, How can it help me.pdf
Micro-Scholarship, What it is, How can it help me.pdf
Introduction to Nonprofit Accounting: The Basics
Introduction to Nonprofit Accounting: The Basics
Magic bus Group work1and 2 (Team 3).pptx
Magic bus Group work1and 2 (Team 3).pptx
Asian American Pacific Islander Month DDSD 2024.pptx
Asian American Pacific Islander Month DDSD 2024.pptx
Unit-IV; Professional Sales Representative (PSR).pptx
Unit-IV; Professional Sales Representative (PSR).pptx
The basics of sentences session 3pptx.pptx
The basics of sentences session 3pptx.pptx
US health care system overview 1
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Major Characteristics of U.S. Health Care Delivery
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