Do HMOs have monopsony power?
OBJECTIVE
To determine whether health maintenance organizations (HMOs) have monopsony power in the markets for ambulatory care and inpatient hospital services.


METHODS
A pooled time-series of data on all HMOs operating in the United States from 1985 through 1997. Information reported to InterStudy on HMO market areas and enrollment is linked to financial data reported to state regulators and county characteristics from the Area Resource File (ARF).


METHODS
We use a two-stage design to test for the existence of monopsony power. First, we estimate regression equations for the prices paid by HMOs for ambulatory visits and inpatient hospital days. The key independent variable is a measure of the importance of an individual HMO as a buyer of ambulatory care or hospital services. Second, we estimate regressions for the utilization of ambulatory visits and inpatient hospital days per HMO enrollee, as a function of HMO buying power and other variables.


RESULTS
Increased HMO buying power is associated with lower price and higher utilization of hospital services. Buying power is not related to ambulatory visit price or utilization per member.


CONCLUSIONS
Our findings are not consistent with the monopsony hypothesis. They suggest that managed care organizations have contributed to a welfare-increasing breakup of hospital monopoly power. The role of HMOs as buyers of ambulatory services is more complex. We discuss possible reasons why buying power may not affect price or utilization of ambulatory visits.
Feldman
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Division of Health Services Research and Policy, University of Minnesota, 420 Delaware St, SE, Box 729, Minneapolis, MN 55455, USA. feldm002@tc.umn.edu
Wholey
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D
D000553:Ambulatory Care / Q000191:economics; D004465:Economic Competition; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000191:economics*; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D011209:Power, Psychological; D014481:United States