Input and Technology Choices in Regulated Industries: Evidence from the Health Care Sector

This paper examines the implications of regulatory change for input mix and technology choices of regulated industries. We study the increase in the relative price of labor faced by U.S. hospitals that resulted from the move from full cost to partial cost reimbursement under the Medicare Prospective Payment System (PPS) reform. Using the interaction of hospitals’ pre‐PPS Medicare share of patient days with the introduction of PPS, we document substantial increases in capital‐labor ratios and declines in labor inputs following PPS. Most interestingly, we find that PPS seems to have encouraged the adoption of a range of new medical technologies.

[1]  Paul A. David,et al.  Technical Choice Innovation and Economic Growth: Essays on American and British Experience in the Nineteenth Century , 1975 .

[2]  D. Acemoglu Technical Change, Inequality, and the Labor Market , 2000 .

[3]  Medicare Reimbursement and Hospital Cost Growth , 1996 .

[4]  T. Waters,et al.  Pricing the Priceless: A Health Care Conundrum , 2003, Nature Medicine.

[5]  Burton A. Weisbrod,et al.  The Health Care Quadrilemma: An Essay on Technological Change, Insurance, Quality of Care, and Cost Containment , 1991 .

[6]  Mark McClellan,et al.  Hospital Reimbursement Incentives: An Empirical Analysis , 1997 .

[7]  Jerome L. Stein,et al.  Behavior of the Firm Under Regulatory Constraint , 1972 .

[8]  Zvi Griliches,et al.  Capital-Skill Complementarity , 1969 .

[9]  P. Cotterill Prospective payment for Medicare hospital capital: implications of the research. , 1991, Health care financing review. Annual supplement.

[10]  J. Spetz,et al.  Is There Monopsony in the Labor Market? Evidence from a Natural Experiment , 1999, Journal of Labor Economics.

[11]  S. Zuckerman,et al.  How did Medicare's prospective payment system affect hospitals? , 1987, The New England journal of medicine.

[12]  D. Wise,et al.  Advances in the Economics of Aging , 1997 .

[13]  Daron Acemoglu,et al.  Market Size in Innovation: Theory and Evidence from the Pharmaceutical Industry , 2003 .

[14]  Jeffrey M. Woodbridge Econometric Analysis of Cross Section and Panel Data , 2002 .

[15]  L. Baker,et al.  Managed Care, Technology Adoption, and Health Care: The Adoption of Neonatal Intensive Care , 2000, The Rand journal of economics.

[16]  Joseph P. Newhouse Pricing the Priceless: A Health Care Conundrum , 2002 .

[17]  D. Cutler,et al.  Managed Care and the Growth of Medical Expenditures , 1997 .

[18]  J. Antos Waivers, research, and health system reform. , 1993, Health affairs.

[19]  J. Booth,et al.  Resampling-Based Multiple Testing. , 1994 .

[20]  D. Grabowski,et al.  Factor substitution in nursing homes. , 2006, Journal of health economics.

[21]  A. Jaffe,et al.  The Induced Innovation Hypothesis and Energy-Saving Technological Change , 1998 .

[22]  P. Cotterill Prospective payment for Medicare hospital capital: Implications of the research , 1992, Health care financing review.

[23]  David M. Cutler,et al.  Your Money or Your Life: Strong Medicine for America's Health Care System , 2004 .

[24]  H. J. Habakkuk,et al.  Second Thoughts on American and British Technology in the Nineteenth Century , 1963 .

[25]  V. Fuchs,et al.  Economics, values, and health care reform. , 1996, The American economic review.

[26]  J. Newhouse,et al.  Medical care costs: how much welfare loss? , 1992, The journal of economic perspectives : a journal of the American Economic Association.

[27]  P. Douglas,et al.  The Theory of Wages , 1934 .

[28]  D. Cutler The Incidence of Adverse Medical Outcomes Under Prospective Payments , 1993 .

[29]  Han Bleichrodt,et al.  Handbook of Health Economics , 2001 .

[30]  J. Hogg Magnetic resonance imaging. , 1994, Journal of the Royal Naval Medical Service.

[31]  Per Krusell,et al.  Federal Reserve Bank of Minneapolis Research Department Staa Report # 236 Capital-skill Complementarity and Inequality: a Macroeconomic Analysis , 2022 .

[32]  L. Baker,et al.  The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare. , 1997, Journal of health economics.

[33]  Simon Cowan,et al.  Regulatory Reform: Economic Analysis and British Experience , 1994 .

[34]  William J. Baumol,et al.  Input choices and rate-of-return regulation : an overview of the discussion , 1970 .

[35]  C. Boothe,et al.  Medicare's prospective payment system. , 1984, American pharmacy.

[36]  C. Goodman Prospective Payment Assessment Commission , 1988 .

[37]  F A Sloan,et al.  Medicare Prospective Payment and the Use of Medical Technologies in Hospitals , 1988, Medical care.

[38]  Jeffrey B. Liebman,et al.  Experimental Analysis of Neighborhood Effects on Youth , 2004 .

[39]  F. Sloan Not-for-profit ownership and hospital behavior , 2000 .

[40]  Lawrence F. Katz,et al.  Computing Inequality: Have Computers Changed the Labor Market? , 1997 .

[41]  P. Joskow,et al.  Incentive Regulation in Theory and Practice: Electricity Distribution and Transmission Networks , 2005 .

[42]  S. S. Young,et al.  Resampling-Based Multiple Testing: Examples and Methods for p-Value Adjustment , 1993 .

[43]  N. Kiefer Economic Duration Data and Hazard Functions , 1988 .

[44]  Akira Takayama,et al.  Behavior of the Firm under Regulatory Constraint , 1969 .

[45]  John Hicks,et al.  The Theory of Wages , 1933 .

[46]  Jerry A. Hausman,et al.  Errors in Variables in Panel Data , 1984 .

[47]  J. Hausman,et al.  Flexible parametric estimation of duration and competing risk models , 1990 .

[48]  William Creager,et al.  Office of Technology Assessment (OTA) , 2001 .

[49]  Amy N. Finkelstein The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare , 2007 .

[50]  Robert F. Coulam,et al.  Medicare's prospective payment system: A critical appraisal , 1992, Health care financing review.

[51]  Z. Griliches,et al.  Changes in the Demand for Skilled Labor within U. S. Manufacturing: Evidence from the Annual Survey of Manufactures , 1994 .

[52]  Amy N. Finkelstein Static and Dynamic Effects of Health Policy: Evidence from the Vaccine Industry , 2004 .

[53]  D. Staiger,et al.  Fiscal Shenanigans, Targeted Federal Health Care Funds, and Patient Mortality , 2004, The quarterly journal of economics.

[54]  Robert E. Evenson,et al.  Induced Innovation: Technology, Institutions, and Development , 1978 .

[55]  D. Acemoglu Factor Prices and Technical Change: From Induced Innovations to Recent Debates , 2001 .

[56]  J. Laffont,et al.  A Theory of Incentives in Procurement and Regulation , 1993 .

[57]  A. Gouveia Your Money or Your Life: Strong Medicine for America's Health Care System , 2006 .

[58]  Leemore S. Dafny How Do Hospitals Respond to Price Changes? , 2003, The American economic review.

[59]  Z. Griliches,et al.  Econometric Models for Count Data with an Application to the Patents-R&D Relationship , 1984 .