title: Market structure and hospital-insurer bargaining in the Netherlands.
abstract: In 2005, competition was introduced in part of the hospital market in the Netherlands. Using a unique dataset of transactions and list prices between hospitals and insurers in the years 2005 and 2006, we estimate the influence of buyer and seller concentration on the negotiated prices. First, we use a traditional structure-conduct-performance model (SCP-model) along the lines of Melnick et al. (J Health Econ 11(3): 217-233, 1992) to estimate the effects of buyer and seller concentration on price-cost margins. Second, we model the interaction between hospitals and insurers in the context of a generalized bargaining model similar to Brooks et al. (J Health Econ 16: 417-434, 1997). In the SCP-model, we find that the market shares of hospitals (insurers) have a significantly positive (negative) impact on the hospital price-cost margin. In the bargaining model, we find a significant negative effect of insurer concentration, but no significant effect of hospital concentration. In both models, we find a significant impact of idiosyncratic effects on the market outcomes. This is consistent with the fact that the Dutch hospital sector is not yet in a long-run equilibrium.
authors.affiliation: The Dutch Healthcare Authority, Postbus 3017, 3502 Utrecht, GA, The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: Halbersma
authors.forename: M C
authors.initials: MC
authors.lastname: Mikkers
authors.forename: E
authors.initials: E
authors.lastname: Motchenkova
authors.forename: I
authors.initials: I
authors.lastname: Seinen
mesh_terms: D003363:Cost Control; D004465:Economic Competition / Q000191:economics / Q000706:statistics & numerical data; D004469:Economics, Hospital / Q000706:statistics & numerical data*; D018166:Health Care Reform; D006761:Hospitals; D006801:Humans; D007349:Insurance, Health, Reimbursement; D040541:Marketing / Q000191:economics*; D017059:Models, Econometric; D017008:Negotiating; D009426:Netherlands; D011907:Rate Setting and Review