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The article examines recent court decisions in South Africa regarding merger control and competition law interpretation. Two mergers were blocked due to concerns about potential price increases, even though they would not have impacted competition before the mergers. The Constitutional Court and the Competition Tribunal both determined that price increases alone can constitute a significant reduction or prevention of competition. The article raises questions about the rationale behind these decisions and their potential consequences. It discusses specific cases involving a private hospital merger and a merger involving an industrial chemical used in gold mining. The article also analyzes the Sasol/Draslovka merger and its impact on the pricing of liquid NaCN. The Tribunal concluded that the price increase resulting from the merger could be considered a substantial reduction or prevention of competition, but the article challenges this conclusion and its implications for future mergers. [Extracted from the article]

COVID-19 has heralded a health and socioeconomic crisis that has made it difficult for nonprofit human service organizations (NPHSOs) to play their social roles and achieve their goals. This article examines how the merger of NPHSOs can serve as a strategy for coping with an organizational crisis caused by external extreme events such as the COVID-19 pandemic. The study focused on eight mergers of Israeli NPHSOs. Using in-depth interviews and a survey methodology of senior managers and board members who have participated in the merger process, we explore the motives, challenges, and key processes characterizing these mergers. The findings are organized around three stages in the merging process – the Three P's in human service mergers: Pre-merger, when the motives and barriers were examined; Process, where decision-making mechanisms, issues of belonging and identity, and coping with conflicts and trust-building were examined; and Post-merger, where attitudes toward the outcomes of the merger and its success in various organizational areas were assessed. The findings also point to a lack of proper preparation and orientation for the merger, ego struggles between managers and workers, and the need for socializing the employees to the merger. We conclude by discussing the importance of planning for and attending to the human capital in the merged NPHSOs, the need to build a shared sense of belonging, and the value of shaping a new and shared organizational culture. Implications to theory, practice, and policy are discussed. Executives of nonprofit human service organizations considering a merger in response to a crisis should prepare, orient, and socialize executives, board members, and employees before entering the merger process; part of this socialization should include emotional dimensions of trust building, respect, and empathy. Executives should establish mechanisms for shared decision-making and for coping with conflicts. Executives and board members should collaborate to plan the merger strategically (i.e. establish goals before initiating the merger) to make the process more efficient, effective, and adjusted to expected and unexpected events in the external environments. Umbrella organizations, infrastructure organizations, government agencies, and funders should develop knowledge and support systems to help organizations consider mergers. Funders should be engaged in due diligence to assess the organizations' financial and economic resilience before the merger. They should also consider the synergies of the merger and its added value to the beneficiaries before entering the process. [ABSTRACT FROM AUTHOR]

This case study of the merger of four hospitals in western Victoria reports on the views of participants affected by the merger – as staff or from the communities – about 2 years after the merger. Respondents reported that many of the sought-after benefits of the merger were being delivered. However, the merger process itself attracted criticism, and it is here that this merger can provide lessons for others. Although there was a long lead time of consultation prior to the formal decision to merge, there was very little time to plan the next steps of implementation – there were only days between the decision and the merger taking effect. Future mergers should manage that differently. There is also a lot of literature on mergers which might provide a check list to enhance the likelihood of success in future mergers. What is known about the topic? Studies on the effect of mergers have largely focused on economic parameters rather than on quality of care or stakeholder perceptions. What does this paper add? This article provides practical insights into the experiences of key people impacted by a health services amalgamation. What are the implications for practitioners? The lessons learnt discussed in the article may assist health services staff in their planning and approach for future amalgamation of health services in a regional/rural setting. [ABSTRACT FROM AUTHOR]

Objective: The recent consolidation of the Australian residential aged care market has raised concerns about the potential adverse effects of acquisition activity on quality of care (QoC). We examined changes in QoC outcomes within acquired homes and the influence of the acquiring providers' characteristics on these post‐acquisition outcomes. Methods: A retrospective observational study was conducted using de‐identified data sets obtained under the legal authority of the Royal Commission into Aged Care Quality and Safety. Regression analysis was used to investigate post‐acquisition changes in QoC outcomes for 225 Australian home acquisitions between 2015 and 2019. The outcomes were analysed for the first two full financial years before and after the acquisition. Results: After controlling for other factors, we find acquired homes were associated with significantly worse QoC outcomes in the 2 years after acquisition, with higher rates of hospitalisations and reported complaints to the regulator. However, these results were driven by homes acquired by providers that were smaller in scale, for‐profit or had comparatively poorer average quality across the other homes they operated. Conclusions: Our finding that homes' QoC on average declines in the first 2 years following acquisition, are consistent with studies in other countries and points to the potential risks that consolidation poses to the care delivered to older people in Australia during that period. [ABSTRACT FROM AUTHOR]

Purpose: Availability of adequate and appropriate trauma care is essential. A merger of two Dutch academic level-1 trauma centers is upcoming. However, in the literature, volume effects after a merger are inconclusive. This study aimed to examine the premerger demand for level-1 trauma care on integrated acute trauma care and evaluate the expected demand on the system. Methods: A retrospective observational study was conducted between 1-1-2018 and 1-1-2019 in two level-1 trauma centers in the Amsterdam region using data derived from the local trauma registries and electronic patient records. All trauma patients presented at both centers' Emergency Departments (ED) were included. Patient- and injury characteristics and data concerning all prehospital and in-hospital-delivered trauma care were collected and compared. Pragmatically, the demand for trauma care in the post-merger setting was considered a sum of care demand for both centers. Results: In total, 8277 trauma patients were presented at both EDs, 4996 (60.4%) at location A and 3281 (39.6%) at location B. Overall, 462 patients were considered severely injured patients (Injury Severity Score ≥ 16). In total, 702 emergency surgeries (< 24 h) were performed, and 442 patients were admitted to the ICU. The sum care demand of both centers resulted in a 167.4% increase in trauma patients and a 151.1% increase in severely injured patients. Moreover, on 96 occasions annually, two or more patients within the same hour would require advanced trauma resuscitation by a specialized team or emergency surgery. Conclusion: A merger of two Dutch level-1 trauma centers would, in this scenario, result in a more than 150% increase in the post-merger setting's demand for integrated acute trauma care. [ABSTRACT FROM AUTHOR]

The integration of social psychiatry and clinical anthropology has a rich history marked by shared interests in phenomenology and scientific epidemiology, shaping mental healthcare significantly. Social psychiatrists and clinical anthropologists strive for a holistic comprehension of mental illnesses through extensive research and deepening knowledge of their respective disciplines. The amalgamation of social psychiatry and anthropology helps elucidate the complex interplay between mental health and societal dynamics, fostering culturally sensitive care. Anthropology offers a comparative understanding of mental health care, highlighting the influence of culture on the experience of mental stress and care provision. It also addresses research gaps and promotes interdisciplinary collaboration. Transdisciplinary approaches bridge clinical practice and social context in public mental health, providing comprehensive insights into mental health issues, and paving the way for culturally informed interventions. Applied anthropology, particularly, plays a crucial role in evaluating community acceptance of health initiatives and developing effective interventions tailored to specific contexts. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effect of consolidation on the performance of Krakatau Medika Hospital below a group called Indonesia Healthcare Corporation (IHC). The concept of consolidation in the healthcare sector is the focus of the study due to the lack of research that examines this phenomenon in depth. The data used includes several hospital performance indicators, such as operational efficiency, service quality, finance, and other important aspects. By using the Balance Scorecard and paired Friedman test, the study reveals that even though the score of performance from the Balance Scorecard gradually improved after the consolidation, the significance of the analyzed data is below 0.05, indicating that there is no remarkable impact of consolidation towards the hospital's performance. It is advised to take more time to do in-depth research to see how the consolidation impacted the hospital. [ABSTRACT FROM AUTHOR]

This article discusses three projects of economic significance that the Competition and Markets Authority (CMA) completed in the last year: First, we discuss the dynamic competition concerns that were at the heart of the CMA's analysis of the Meta/GIPHY merger; this was the first case of a competition authority's blocking an acquisition by one of the 'Big Tech' firms. Second, our work on the road fuels market study examined pricing behaviour in an important consumer-facing market and found that competition had weakened because historic price leaders have been taking a less aggressive approach to pricing, Third, we established a new research centre—the Microeconomics Unit—to bring economic expertise on competition, innovation, and productivity closer to regulatory and policy decisions. [ABSTRACT FROM AUTHOR]

The U.S. Federal Trade Commission enforces federal competition and consumer protection laws that prevent anticompetitive, deceptive, and unfair business practices, and works to advance government policies that protect consumers and promote competition. The FTC's Bureau of Economics performs economic analysis to support both the enforcement and policy activities of the Commission. This article discusses several examples of these activities. We first discuss some work our economists have done on spatial considerations in demand estimation, and then present an analytical approach that has been developed to assess consumer choice between service providers with the use of data on geographic variation in the location of the customers of two merging service providers. We apply this technique in the context of the analysis of the competitive effects of a merger of veterinary hospitals. Next, we discuss an important tool in the FTC's arsenal: rulemaking. We describe the benefits and costs of rulemaking, the rulemaking process, and the role of economic analysis in that process, and then highlight recent FTC rulemaking activities and the economic analysis of a proposed rulemaking that would ban employers from imposing non-compete clauses in employment contracts. [ABSTRACT FROM AUTHOR]

The static analysis shows that a merger among complementary input suppliers or complementary patent holders benefits the consumers and the society by reducing the input prices. We show that the effects of a merger of complements are not so straightforward in a dynamic set up with endogenous product differentiation in the final goods market. The merger of complements reduces the total input prices and increases product differentiation. However, whether it increases or decreases consumer surplus and welfare depends on the market expansion following product differentiation, the number of merged input suppliers and the intensity of competition. Hence, in a dynamic setup with endogenous product differentiation, the antitrust authorities may need to be more careful about mergers of complements. Our analysis has also relevance for vertical mergers. • We show mergers of complements may make the consumers and the society worse off. • Endogenous product differentiation in the final goods market constitutes our results. • Our results hold under Bertrand and Cournot competition in the final goods market. • Market expansion, competition, and number of merged input suppliers are important. • Important for vertical merger and different from the results under static analysis. [ABSTRACT FROM AUTHOR]

Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations. In the first part of this review we proposed an operational definition that incorporates the processes by which products are manufactured, the causes of shortages and stock‐outs (local shortages), and the contributory factors. Here we discuss causes and possible solutions. Drug shortages have complex causes, and a single cause cannot always be identified. Reasons include lack or shortage of raw materials, manufacturing difficulties, regulatory and political actions, voluntary recalls, just‐in‐time inventory systems, halts in production for financial or other business reasons, low demand (eg, orphan products, reduced usage), mergers, market shifts (eg, diversion to home markets) and unexpected increases in demand (eg, improved diagnosis, new trial information, epidemics and pandemics, inappropriate use, off‐label use). Potential solutions are as diverse as the potential causes. Prevention is hard, because shortages are not easily predicted. Everyone in the supply chain is involved in anticipating and managing shortages, with responsibilities for preventing them or at least trying to mitigate their effects. This includes manufacturers and suppliers, particularly of generic formulations, pharmacists, prescribers, patients and governments. Solutions can therefore be linked to the causes and classified according to where the responsibility for implementing them lies. [ABSTRACT FROM AUTHOR]

Many hospitals have achieved high levels of lean performance only to lose it later on. This research develops a theoretical understanding of how organisations can sustain lean in healthcare, through a practical and innovative framework to assess the maturity level of lean in healthcare that can be used by both practitioners and academics. Through the analysis of the literature, it was possible to compile 22 main critical success factors of lean sustainability in hospitals. A comparative case study provides evidence to confirm these 22 theoretical propositions, and also to add other 3 new success factors to the framework. The proposed framework allows hospitals to conduct a structured process of change, with all the foundation needed to succeed and sustain the lean journey in the long-term. New insights are revealed by studying hospitals after minimum 18 months of lean implementation and comparing the ones that have achieved a high level of lean sustainability with those that did not. To the best of our knowledge, this article is the first to attempt to bring together the key factors that influence hospitals to sustain lean improvements in the long term. [ABSTRACT FROM AUTHOR]

Policy PointsPolicymakers should invest in programs to support rural health systems, with a more targeted focus on spatial accessibility and racial and ethnic equity, not only total supply or nearest facility measures.Health plan network adequacy standards should address spatial access to nearest and second nearest hospital care and incorporate equity standards for Black and Latinx rural communities.Black and Latinx rural residents contend with inequities in spatial access to hospital care, which arise from fundamental structural inequities in spatial allocation of economic opportunity in rural communities of color. Long‐term policy solutions including reparations are needed to address these underlying processes. Context: The growing rate of rural hospital closures elicits concerns about declining access to hospital‐based care. Our research objectives were as follows: 1) characterize the change in rural hospital supply in the US South between 2007 and 2018, accounting for health system closures, mergers, and conversions; 2) quantify spatial accessibility (in 2018) for populations most at risk for adverse outcomes following hospital closure—Black and Latinx rural communities; and 3) use multilevel modeling to examine relationships between structural factors and disparities in spatial access to care. Methods: To calculate spatial access, we estimated the network travel distance and time between the census tract–level population‐weighted centroids to the nearest and second nearest operating hospital in the years 2007 and 2018. Thereafter, to describe the demographic and health system characteristics of places in relation to spatial accessibility to hospital‐based care in 2018, we estimated three‐level (tract, county, state‐level) generalized linear models. Findings: We found that 72 (10%) rural counties in the South had ≥1 hospital closure between 2007 and 2018, and nearly half of closure counties (33) lost their last remaining hospital to closure. Net of closures, mergers, and conversions meant hospital supply declined from 783 to 653. Overall, 49.1% of rural tracts experienced worsened spatial access to their nearest hospital, whereas smaller proportions experienced improved (32.4%) or unchanged (18.5%) access between 2007 and 2018. Tracts located within closure counties had longer travel times to the nearest acute care hospital compared with tracts in nonclosure counties. Moreover, rural tracts within Southern states with more concentrated commercial health insurance markets had shorter travel times to access the second nearest hospital. Conclusions: Rural places affected by rural hospital closures have greater travel burdens for acute care. Across the rural South, racial/ethnic inequities in spatial access to acute care are most pronounced when travel times to the second nearest open acute care hospital are accounted for. [ABSTRACT FROM AUTHOR]

Hospitals seeking to understand patient safety strengths and vulnerabilities in the context of mergers/acquisitions benefit more from a third‐party perspective than from a limited internal process. A well‐structured and highly‐inclusive risk assessment—involving a broad cross‐section of interviews—can be key to a successful transition of optimal health care safety during organizational changes. [ABSTRACT FROM AUTHOR]

Private equity acquisition of medical groups and health care organizations is becoming increasingly important in medicine and is a trend that is likely to continue for the foreseeable future. Some question the ethical implications of private equity acquisitions, since the clear goal of such organizations is maximizing profitability, which may or may not be in the best interests of either the patient population or the provider group. This article will describe the role of private equity in the medical marketplace, with a focus on the role of private equity in radiology and interventional radiology specifically. Additionally, this article will explore this growing trend in the radiology marketplace and its anticipated effects upon patient care and professional satisfaction for radiologists. [ABSTRACT FROM AUTHOR]

Policy PointsHospital executives posit a number of rationales for system mergers which lack any basis in academic evidence. Decades of academic research question whether system combinations confer public benefits. Antitrust authorities need to continue to closely scrutinize these transactions.Recently, mergers of hospital systems that span different geographic markets are on the rise. Economists have alerted policymakers about the potential impacts such cross‐market mergers may have on hospital prices. We suggest there are other reasons for concern that scholars have not often confonted. Cross‐market mergers may be conducted for purely self‐serving reasons of organizational growth that increases executive compensation. Combinations of sellers should have clear advantages to consumers. System executives and their boards should bear the burden of proof.Federal regulators and state attorney generals should be cognizant that rationales for cross‐market systems advanced by merging parties are unlikely to be operative or dominant in merger decision making.Policymakers should be careful about passing legislation that encourages hospitals to consolidate. Context: There is a growing trend of combinations among hospital systems that operate in different geographic markets known as cross‐market mergers. Economists have analyzed these broader systems in terms of their anticompetitive behavior and pricing power over insurers. This paper evaluates the benefits advanced by these new hospital systems that speak to a different set of issues not usually studied: increased efficiencies, new capabilities, operating synergies, and addressing health inequities. The paper thus "looks under the hood" of these emerging, cross‐market systems to assess what value they might bestow and upon whom. Methods: The paper examines recently announced cross‐market mergers in terms of their supposed benefits, as expressed by the systems' executives as well as by industry consultants. These presumed benefits are then evaluated against existing evidence regarding hospital system outcomes. Findings: Advocates of cross‐market hospital mergers cite a host of benefits. Research suggests these benefits are nonexistent. Additional evidence suggests other motives may be at play in the formation of cross‐market mergers that have nothing to do with efficiencies, synergies, or community benefits. Instead these mergers may be self‐serving efforts by system chief executive officers (CEOs) to boost their compensation. Conclusions: Cross‐market hospital mergers may yield no benefits to the hospitals involved or the communities in which they operate. The boards of hospital systems that engage in these cross‐market mergers need to exercise greater diligence over the actions of their CEOs. [ABSTRACT FROM AUTHOR]

Problem definition: Under the prevailing fee-for-service (FFS) payments, hospitals receive a fixed payment, whereas physicians receive separate fees for each treatment or procedure performed for a given diagnosis. Under FFS, incentives of hospitals and physicians are misaligned, leading to large inefficiencies. Bundled payments (BP), an alternative to FFS unifying payments to the hospital and physicians, are expected to encourage care coordination and reduce ever increasing healthcare costs. However, as hospitals differ in their relationships with physicians in influencing care (level of physician integration), the expected effects of bundling in hospital systems with a varying level of physician integration remains unclear. Academic/practical relevance: There is a lack of both academic and practical understanding of hospitals' and physicians' bundling incentives. Our study builds on and expands the recent operations management literature on alternative payment models. Methodology: We formulate game-theoretic models to study (1) the impact of the level of integration between the hospital and physicians in the uptake of BP and (2) the consequences of bundling with respect to overall care quality and costs/savings across the spectrum of integration levels. Results: We find that (1) hospitals with low to moderate levels of physician integration have more incentives to bundle as compared with hospitals with high physician integration; (2) to engage physicians, hospitals need to financially incentivize them, a mechanism that was not available in traditional FFS-based payment models; (3) when feasible, BP is expected to reduce care intensity, and this reduction in care intensity is expected to result in quality improvement and cost savings in hospital systems with low to moderate level of physician integration; (4) however, when bundling happens in hospital systems with a relatively higher level of physician integration, BP may lead to underprovisioning of care and ultimately quality reduction; (5) in an environment where hospitals are also held accountable for quality, the incentives for bundling will be higher for involved parties, yet quality vulnerabilities due to bundling can be exacerbated. Managerial implications: Our findings have important managerial implications for policy makers, payers such as the Center for Medicare and Medicaid Services, and hospitals: (1) policy makers and payers should be aware of and account for potential negative effects of current BP design on a subset of hospital systems, including a possible quality reduction; (2) in deciding whether to enroll in BP, hospitals should consider their level of physician integration and possible implications for quality. Based on our findings, we expect that a widespread use of BP may trigger further market concentration via hospital mergers or service-line closures. Supplemental Material: The online appendices are available at https://doi.org/10.1287/msom.2023.1187. [ABSTRACT FROM AUTHOR]

Financial distress among rural hospitals in the US has increased in recent years. Using national hospital data, we investigated how the decline in profitability has affected hospital survival, either independently or with a merger. The answer has direct implications for access to care and competition in rural markets. We assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010-18, focusing on hospitals that were unprofitable at baseline. A minority of unprofitable hospitals (7 percent) closed. A larger share (17 percent) merged, most commonly with organizations from outside of their local geographic market. Most unprofitable hospitals (77 percent) continued to operate through 2018 without closure or merger. About half of these hospitals returned to profitability. At the market level, 22 percent of markets served by unprofitable hospitals lost a competitor to closure or within-market merger. Out-of-market mergers affected 33 percent of markets with an unprofitable hospital. Overall, our results suggest that rural markets are experiencing meaningful rates of hospital closures and mergers, yet many hospitals have survived despite poor financial performance. Policies targeting access to care will continue to be important. Similar attention will be needed to address the competitive effects of hospital closures and mergers on prices and quality. [ABSTRACT FROM AUTHOR]

As healthcare markets continue to consolidate and prices continue to rise, economists, legal scholars, antitrust enforcers, and policymakers have the opportunity and the obligation to examine how the dynamics of our healthcare markets have changed over time and how those changes affect consumers and competition. Although antitrust merger law is designed to arrest anticompetitive harms in their incipiency, it has failed to prevent anticompetitive consolidation in most sectors of the healthcare industry. Of particular concern is the inattention of antitrust enforcers to the growing market power of healthcare systems that span multiple local geographic markets. While more than half of all hospital mergers have occurred across geographic markets in the last decade, none have been challenged in federal court. Emerging economic data suggest that these mergers can result in price increases for hospitals throughout the newly merged systems, and a number of cases document the propensity of hospital systems to exercise postmerger market power. To accurately reflect the expanding body of knowledge surrounding price and market power in healthcare transactions, the traditional tools of antitrust enforcement must be seen with new eyes. This Article argues that cross-market healthcare transactions can lead to increased prices through a variety of mechanisms and provides a framework for analyzing which mergers may raise competition concerns. Our hope is that this framework will encourage economists, legal scholars, and antitrust enforcers to work collaboratively to identify and restrict the growth of "system power" resulting from anticompetitive cross-market healthcare mergers. [ABSTRACT FROM AUTHOR]

Galactic nuclei harbouring a central supermassive black hole (SMBH), possibly surrounded by a dense nuclear cluster (NC), represent extreme environments that house a complex interplay of many physical processes that uniquely affect stellar formation, evolution, and dynamics. The discovery of gravitational waves (GWs) emitted by merging black holes (BHs) and neutron stars (NSs), funnelled a huge amount of work focused on understanding how compact object binaries (COBs) can pair up and merge together. Here, we review from a theoretical standpoint how different mechanisms concur with the formation, evolution, and merger of COBs around quiescent SMBHs and active galactic nuclei (AGNs), summarising the main predictions for current and future (GW) detections and outlining the possible features that can clearly mark a galactic nuclei origin. [ABSTRACT FROM AUTHOR]

We perform a Monte Carlo experiment to assess the performance of three hospital merger simulation methods. Our analysis proceeds as follows: (i) specify a theoretical model of hospital markets and use it to generate "true" price effects for many simulated mergers; (ii) for each simulated merger, generate data of the kind commonly available in real‐world merger analysis and apply the simulation methods to those data; and (iii) compare the predictions of the simulation methods to the true price effects. All three simulation methods perform reasonably well. We also develop a method for predicting price effects that extends Garmon [2017]. [ABSTRACT FROM AUTHOR]

The English hospital sector underwent a major restructuring program between 2000 and 2008 to centralize activity in fewer and larger hospitals. The aim of this paper is to evaluate the effects of such consolidations on hospital outputs. As mergers occurred in a staggered way, treatment could start and end at every time and treatment duration varied over the years. As every time is a mix of hospital pre‐treatment, treatment and post‐treatment phases, the canonical difference‐in‐differences assumption of homogeneous policy effects is not only meaningless but also misleading, raising doubts about the appropriateness of the methods previously used in this literature and consequently the accuracy of its results. We instead adopt a new matching and difference‐in‐differences approach, the flexible conditional difference‐in‐differences approach, developed by Dettmann et al. in 2020, more appropriate for causal analysis of treatments characterized by varying start dates and varying treatment duration. Our results suggest that mergers downsize hospital activities, especially the most expensive ones. If the goal of hospital mergers is to gain efficiency by centralization of activity, our findings suggest this restructuring programme is not the most successful policy to pursue. Mergers reduce the scope for competition between hospitals and do not create any incentive for poorly performing hospitals. [ABSTRACT FROM AUTHOR]

In this article, we examine the economic and welfare ramifications of antitrust policy intervention in primary‐ and secondary‐line price discrimination in a distribution channel where downstream retailers are vertically related through a strategic upstream manufacturer. Particularly, we focus on a distribution channel where a manufacturer sells his product through retailers in two asymmetric markets. The markets are asymmetric along two dimensions: One exhibits a higher demand/profit potential than does the other; and one is a competitive market where two retailers engage in imperfect price competition, whereas the other is a captive market monopolized by one of the retailers. We characterize the effect of antitrust policy intervention in each form of third‐degree price discrimination on the pricing and selling mechanisms of channel members, consumers, and the channel profits (and hence on the total welfare) for varying degrees of asymmetry on demand potential between the two markets and the extent of product substitutability. We show that under practical demand and competition conditions, contrary to prior literature, antitrust policy intervention in secondary‐line discrimination always benefits the local retailer (the disfavored customer of the manufacturer) and yet is apt to result in a lose–win or lose–lose outcome in addition to a win–win outcome for the channel and society. Second, antitrust policy intervention in primary‐line discrimination so as to protect a localized retailer from the selective price cuts of a chain‐store retailer (rather than to protect competition) can actually result in a win–win outcome. Third, in the absence of antitrust policy intervention, consumers are always harmed by (discriminatory) pricing practices employed in a channel. Those and other findings contribute to the intense debate over the merits and goals of antitrust policy intervention in third‐degree price discrimination in distribution channels by shedding some light on the contractual relationships between manufacturers and retailers and economic forces at play. [ABSTRACT FROM AUTHOR]

This contribution investigates the effects of horizontal mergers and acquisitions on the plant capacity utilisation of Swedish district courts over the period 2000–2017. More specifically, we empirically illustrate the decomposition of input-oriented and output-oriented plant capacity utilisation concepts. Moreover, we also explore the impact of convexity on input-oriented and output-oriented measures of plant capacity in the short-run in an attempt to discover the potential rationale behind the merger wave. To the best of our knowledge, we are the first to assess horizontal mergers by employing plant capacity utilisation concepts. The results indicate that the horizontal mergers improve plant capacity utilisation. Furthermore, the nonconvex frontier method provides a more conservative estimate of plant capacity changes of this merger wave. [ABSTRACT FROM AUTHOR]

The article focuses on U.S. Congress's attention to healthcare consolidation and its implications for costs, quality, and access. It discusses a Senate Finance Committee hearing, where concerns about rising healthcare costs due to consolidation were raised. It explores arguments both for and against consolidation, proposing policy solutions such as strengthening antitrust rules, site-neutral payments, and improving Medicare reimbursement.

While economic theories indicate that market power by downstream firms can potentially counteract market power upstream, antitrust policy is opaque as to whether to incorporate countervailing market power in merger analyses. We use detailed national claims data from the health care sector to evaluate whether countervailing insurer power does indeed limit hospitals' exercise of market power. We estimate willingness-to-pay models to evaluate hospital market power across analysis areas. We find that countervailing market power is important: a typical hospital merger would raise hospital prices 4.3% at the 25th percentile of insurer concentration but only 0.97% at the 75th percentile of insurer concentration. [ABSTRACT FROM AUTHOR]

In 2021, President Biden issued an executive order that addressed the negative implications of market concentration within the healthcare industry. Specifically, President Biden called for the revision of the Horizontal and Vertical Merger Guidelines to enact antitrust safeguards that limit unchecked hospital mergers and promote competition. This Article delves into the role of the healthcare sector in the U.S. economy and how the current state of hospital mergers limits competition and, thus, the quality of care available to patients. Further, this Article studies U.S. federal regulations, case law, and merger retrospectives to uncover pitfalls within the current Horizontal Merger Guidelines. In conclusion, this Article proposes adding hospital-specific language and more context for merger efficiencies to the guidelines as a remedy for its current anticompetitive consequences. [ABSTRACT FROM AUTHOR]

Economists in the U.S. Federal Trade Commission's Bureau of Economics perform economic analysis in support of the Commission's dual missions to protect consumers and competition by preventing anticompetitive, deceptive, and unfair business practices through law enforcement, advocacy, and education. This article first presents summaries of analyses that FTC economists performed to estimate the consumer harm from two different types of deception that involved misleading information about lease terms and suppression of negative product reviews. The essay next turns to economic analyses of mergers: We first consider the vertical issues that arose in a semiconductor merger; and then we provide a discussion of how complementarity between hospitals may affect the analysis of hospital mergers. [ABSTRACT FROM AUTHOR]

Although hospital consolidation within markets has been well documented, consolidation across markets has not, even though economic theory predicts-and evidence is emerging-that cross-market hospital systems raise prices by exerting market power across markets when negotiating with common customers (primarily insurers). This study analyzes hospital systems using the American Hospital Association Annual Survey Database and defines hospital geographic markets as commuting zones that link workers to places of employment. The share of community hospitals in the US that were part of hospital systems increased from 10 percent in 1970 to 67 percent in 2019, resulting in 3,436 hospitals within 368 systems in 2019. Of these systems, 216 (59 percent) owned hospitals in multiple commuting zones, in part because 55 percent of the 1,500 hospitals targeted for a merger or acquisition between 2010 and 2019 were located in a different commuting zone than the acquirer. Based on market-power differences among hospitals in systems, the number of systems in urban commuting zones that could potentially exert enhanced cross-market power increased from thirty-seven systems in 2009 to fifty-seven systems in 2019, an increase of 54 percent. The increase in cross-market hospital systems warrants concern and scrutiny because of the potential anticompetitive impact of hospital systems exerting market power across markets in negotiations with common customers. [ABSTRACT FROM AUTHOR]

The Veterans Health Administration (VHA) purchases community nursing home care; however, the administrative burden may lead nursing homes to avoid contracting with the VHA. This study aimed to describe how the VHA's purchasing policies impede or facilitate contracting with nursing homes. Semistructured interviews of key stakeholders in the VHA's community nursing home contracting process. We interviewed 15 VHA and 21 nursing home staff at 6 VHA medical centers and 17 nursing homes. VHA medical centers were selected from sites with the greatest magnitude of difference in quality rankings between VHA contracted and noncontracted nursing homes in the same market area. Qualitative content analysis of interviews. Five themes emerged: (1) VHA purchases nursing home care to fill gaps in geographic, specialty, and quality care needs; (2) business opportunities and the mission to care for Veterans motivate nursing homes to work with the VHA; (3) the VHA's reputation for unreliable or insufficient payment and inability of nursing homes to comply with federal wage standards serve as barriers to establishing contracts; (4) complexity of establishing a contract, ambiguity about new policies, and inadequate VHA staffing for the nursing home inspection team hinder the VHA's ability to establish contracts with nursing homes; and (5) nursing homes that have established corporate processes, nursing home administrators with prior experience working with the VHA, and relationships between VHA and nursing home staff serve as facilitators to establishing new nursing home contracts. Nursing homes will work with the VHA, but the process of executing VHA contracts is burdensome. Streamlining and standardizing the purchasing processes and ensuring timely payment may expand the number of nursing homes willing to contract with the VHA, thereby increasing choices for Veterans and becoming a model for other long-term care networks. [ABSTRACT FROM AUTHOR]

The article focuses on the partnership between OMRON Healthcare India and AliveCor India to integrate Artificial Intelligence (AI)-based handheld Electrocardiogram (ECG) technology into OMRON's product offerings. Topics include the alignment with OMRON's vision for improving cardiovascular health and the combined functionality of blood pressure and ECG monitoring for early detection of cardiovascular diseases.

Different perspectives on organizations have alternatively sorted them on the side of the social / human / linguistic or that of the material / non-human / technical, reducing the question of what an organization may be to attempts to (re)connect these two realms. Literature adopting a relational view, however, has offered a way out of this opposition, by embracing the multiplicity of beings that may make up organizations. We extend this approach by engaging with French philosopher Étienne Souriau's discussion of modes of existence to suggest that organizations are "synaptic," which means they exist in the passages between modes, as they articulate the actions of entities existing under different modalities. By analyzing the case of a hospital merger in Denmark, we show that this work of articulation amounts to organizing, and that viewing organizations as synaptic recognizes not only their ontic pluralism, but also their existential pluralism. By doing so, our study contributes to relational understandings of what organizing means and provides a sensitivity to the politics involved in deciding who or what may exist within organizations. [ABSTRACT FROM AUTHOR]

The article discusses disruption of the healthcare industry by constant change in 2022. Topics covered include the dependence of a healthcare organization's longevity on its adaptability to change and ability to meet customer expectations, and the need for leaders to proactively reduce costs and boost quality. Also noted is their need to offer high-quality services at attractive prices to sustain the business.

Objective: To determine whether the variation in prices paid for cardiac medical devices was associated with management practices in cardiac units. Study setting: Cardiac units in US hospitals. Study design We regressed unit prices on management practice scores and other hospital characteristics, with and without controls for device fixed effects, for the 11 top‐spending cardiac device categories. Data collection: A trusted third party that had entered into a confidentiality agreement combined de‐identified medical device price data for N = 213 US hospitals from ECRI's Supply Guide benchmarking service, with survey responses regarding management practices in those hospitals' cardiac units; the resulting merged data were made available to researchers for analysis with hospital identifiers removed. N = 1980 hospitals with interventional cardiac catheterization laboratories and at least 25 annual acute myocardial infarction discharges in 2010 were eligible for inclusion; N = 648 responded to the management practices survey; N = 213 subscribed to Supply Guide and purchased at least one of 11 top cardiac medical device categories. Principal findings: Cardiac units with better management practices paid lower prices for cardiac devices (percent decrease in price for one standard deviation increase in management score = 1.33%, 95% confidence interval 0.99–1.67). This was comparable in magnitude to the price decrease associated with a one standard deviation increase in patient volume. Conclusions: Better management practices were associated with lower device prices. This relationship is robust, but modest in magnitude. This modest magnitude is similar, though, to other events expected to lower input prices, such as transparency in the form of benchmarking information and hospital mergers. [ABSTRACT FROM AUTHOR]

Background Despite mergers have increasingly affected hospitals in the recent decades, literature on the impact of hospitals mergers on healthcare quality measures (HQM) is still lacking. Our research aimed to systematically review evidence regarding the impact of hospital mergers on HQM focusing especially on process indicators and clinical outcomes. Methods The search was carried out until January 2020 using the Population, Intervention, Comparison and Outcome model, querying electronic databases (MEDLINE, Scopus, Web Of Science) and refining the search with hand search. Studies that assessed HQM of hospitals that have undergone a merger were included. HQMs were analyzed through a narrative synthesis and a strength of the evidence analysis based on the quality of the studies and the consistency of the findings. Results The 16 articles, included in the narrative synthesis, reported inconsistent findings and few statistically significant results. All indicators analyzed showed an insufficient strength of evidence to achieve conclusive results. However, a tendency in the decrease of the number of beds, hospital staff and inpatient admissions and an increase in both mortality and readmission rate for acute myocardial infarction and stroke emerged in our analysis. Conclusions In our study, there is no strong evidence of improvement or worsening of HQM in hospital mergers. Since a limited amount of studies currently exists, additional studies are needed. In the meanwhile, hospital managers involved in mergers should adopt a clear evaluation framework with indicators that help to periodically and systematically assess HQM ascertaining that mergers ensure and primarily do not reduce the quality of care. [ABSTRACT FROM AUTHOR]

Background: The implications of competition among hospitals on care quality have been the subject of considerable debate. On one hand, economic theory suggests that when prices are regulated, quality will be increased in competitive markets. On the other hand, hospital mergers have been justified by the need to exploit cost advantages, and by evidence that hospital volume and care quality are related. Methods: Based on patient-level data from two years (2005 and 2012) we track changes in market competition and treatment patterns in breast cancer surgery. We focus on technology adoption as a proxy of process quality and examine the likelihood of offering two innovative surgical procedures: immediate breast reconstruction (IBR), after mastectomy and sentinel lymph node biopsy (SLNB). We use an index of competition based on a multinomial logit model of hospital choice which is not subject to endogeneity bias, and estimate its impact on the propensity to receive IBR and SLNB by means of multilevel models taking into account both observable patient and hospital characteristics. Results: The likelihood of receiving these procedures is significantly higher in hospitals located in more competitive markets. Yet, hospital volume remains a significant indicator of quality, therefore benefits of competition appear to be sensitive to the estimates of the impact of volume on care process. In France, the centralisation policy, with minimum activity thresholds, have contributed to improving breast cancer treatment between 2005 and 2012. Conclusion: Finding the right balance between costs and benefits of market competition versus concentration of hospital care supply is complex. We find that close to monopolistic markets do not encourage innovation and quality in cancer treatment, but highly competitive markets where many hospitals have very low activity volumes are also problematic because hospital quality is positively linked to patient volume. [ABSTRACT FROM AUTHOR]