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Health Serv Res. 1997 February; 31(6): 679–699.
PMCID: PMC1070153

Effects of market position and competition on rural hospital closures.


OBJECTIVE: To examine the dynamic effects of competition and hospital market position on rural hospital closures. DATA SOURCE/STUDY SETTING: Analysis of all rural community hospitals operating between 1984 and 1991, with the exception of sole-provider hospitals. Data for the study are obtained from four sources: the AHA Annual Surveys of Hospitals, the HCFA Cost Reports, the Area Resource File, and a hospital address file constructed by Geographic Inc. DATA COLLECTION AND ANALYSIS: Variables are merged to construct pooled, time-series observations for study hospitals. Hospital closure is specified as a function of hospital market position, market level competition, and control variables. Discrete-time logistic regressions are used to test hypotheses. PRINCIPAL FINDINGS: Rural hospitals operating in markets with higher density had higher risk of closure. Rural hospitals that differentiated from others in the market on the basis of geographic distance, basic services, and high-tech services had lower risks of closure. Effects of market density on closure disappeared when market position was included in the model, indicating that differentiation in markets should be taken into account when evaluating the effects of competition on rural hospital closure. CONCLUSIONS: Our findings suggest that rural hospitals can reduce competitive pressures through differentiation and that accurate measures of competition in geographically defined market areas are critical for understanding competitive dynamics among rural hospitals.

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Selected References

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  • Adams EK, Wright GE. Hospital choice of Medicare beneficiaries in a rural market: why not the closest? J Rural Health. 1991 Spring;7(2):134–152. [PubMed]
  • Amundson BA, Rosenblatt RA. The rural hospital project: conceptual background and current status. J Rural Health. 1988 Jul;4(2):119–138. [PubMed]
  • Berry RE., Jr On grouping hospitals for economic analysis. Inquiry. 1973 Dec;10(4):5–12. [PubMed]
  • Bronstein JM, Morrisey MA. Determinants of rural travel distance for obstetrics care. Med Care. 1990 Sep;28(9):853–865. [PubMed]
  • Cleverley WO, Harvey RK. Critical strategies for successful rural hospitals. Health Care Manage Rev. 1992 Winter;17(1):27–33. [PubMed]
  • Connor RA, Kralewski JE, Hillson SD. Measuring geographic access to health care in rural areas. Med Care Rev. 1994 Fall;51(3):337–377. [PubMed]
  • Dranove D, Shanley M, Simon C. Is hospital competition wasteful? Rand J Econ. 1992 Summer;23(2):247–262. [PubMed]
  • Ermann DA. Rural health care: the future of the hospital. Med Care Rev. 1990 Spring;47(1):33–73. [PubMed]
  • Folland ST. Predicting hospital market shares. Inquiry. 1983 Spring;20(1):34–44. [PubMed]
  • Goody B. Defining rural hospital markets. Health Serv Res. 1993 Jun;28(2):183–200. [PMC free article] [PubMed]
  • Hughes RG, Luft HS. Service patterns in local hospital markets: complementarity or medical arms race? Health Serv Manage Res. 1991 Jul;4(2):131–139. [PubMed]
  • Javalgi RG, Rao SR, Thomas EG. Choosing a hospital: analysis of consumer tradeoffs. J Health Care Mark. 1991 Mar;11(1):12–22. [PubMed]
  • Kane NM. Hospital profits, a misleading measure of financial health. J Am Health Policy. 1991 Jul-Aug;1(1):27–35. [PubMed]
  • Lane PM, Lindquist JD. Hospital choice: a summary of the key empirical and hypothetical findings of the 1980s. J Health Care Mark. 1988 Dec;8(4):5–20. [PubMed]
  • Lillie-Blanton M, Felt S, Redmon P, Renn S, Machlin S, Wennar E. Rural and urban hospital closures, 1985-1988: operating and environmental characteristics that affect risk. Inquiry. 1992 Fall;29(3):332–344. [PubMed]
  • Luke RD. Spatial competition and cooperation in local hospital markets. Med Care Rev. 1991 Summer;48(2):207–237. [PubMed]
  • Mayer JD, Kohlenberg ER, Sieferman GE, Rosenblatt RA. Patterns of rural hospital closure in the United States. Soc Sci Med. 1987;24(4):327–334. [PubMed]
  • McDermott RE, Cornia GC, Parsons RJ. The economic impact of hospitals in rural communities. J Rural Health. 1991 Spring;7(2):117–133. [PubMed]
  • McGuirk MA, Porell FW. Spatial patterns of hospital utilization: the impact of distance and time. Inquiry. 1984 Spring;21(1):84–95. [PubMed]
  • Melnick GA, Zwanziger J, Bamezai A, Pattison R. The effects of market structure and bargaining position on hospital prices. J Health Econ. 1992 Oct;11(3):217–233. [PubMed]
  • Mick SS, Morlock LL, Salkever D, de Lissovoy G, Malitz FE, Wise CG, Jones AS. Horizontal and vertical integration-diversification in rural hospitals: a national study of strategic activity, 1983-1988. J Rural Health. 1993 Spring;9(2):99–119. [PubMed]
  • Morrisey MA, Sloan FA, Valvona J. Defining geographic markets for hospital care. Law Contemp Probl. 1988 Spring;51(2):165–194. [PubMed]
  • Mullner RM, Rydman RJ, Whiteis DG. Rural hospital survival: an analysis of facilities and services correlated with risk of closure. Hosp Health Serv Adm. 1990 Spring;35(1):121–137. [PubMed]
  • Mullner RM, Rydman RJ, Whiteis DG, Rich RF. Rural community hospitals and factors correlated with their risk of closing. Public Health Rep. 1989 Jul-Aug;104(4):315–325. [PMC free article] [PubMed]
  • Mullner RM, Whiteis DS. Rural community hospital closure and health policy. Health Policy. 1988 Oct;10(2):123–135. [PubMed]
  • Phibbs CS, Robinson JC. A variable-radius measure of local hospital market structure. Health Serv Res. 1993 Aug;28(3):313–324. [PMC free article] [PubMed]
  • Shortell SM. The evolution of hospital systems: unfulfilled promises and self-fulfilling prophesies. Med Care Rev. 1988 Fall;45(2):177–214. [PubMed]
  • Sloan FA, Morrisey MA, Valvona J. Medicare prospective payment and the use of medical technologies in hospitals. Med Care. 1988 Sep;26(9):837–853. [PubMed]
  • Starkweather DB, Carman JM. The limits of power in hospital markets. Med Care Rev. 1988 Spring;45(1):5–49. [PubMed]
  • White SL, Chirikos TN. Measuring hospital competition. Med Care. 1988 Mar;26(3):256–262. [PubMed]
  • Williams D, Hadley J, Pettengill J. Profits, community role, and hospital closure: an urban and rural analysis. Med Care. 1992 Feb;30(2):174–187. [PubMed]
  • Zeger SL, Liang KY. An overview of methods for the analysis of longitudinal data. Stat Med. 1992 Oct-Nov;11(14-15):1825–1839. [PubMed]

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