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  5. The Economics of Hospital Mergers
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The Economics of Hospital Mergers

Paper Session

Sunday, Jan. 4, 2026 10:15 AM - 12:15 PM (EST)

Philadelphia Convention Center, 309
Hosted By: American Economic Association
  • Chair: Marshall Steinbaum, University of Utah

Health Provider Concentration and Medical Debt

Alaa Abdelfattah
,
New York University-Abu Dhabi
Sergio Pinto
,
Organization for Economic Cooperation and Development
Marshall Steinbaum
,
University of Utah
Justin Wiltshire
,
University of Victoria

Abstract

We leverage consumer credit panel data to examine the impact of hospital consolidation on individual medical debt. Using a stacked event study research design, we find that exposure to a hospital merger increases the probability that individuals have medical debt one year later by 1.9 percent. Despite this, we find no early evidence that mergers increase average medical debt flow. The two results together suggest that some individuals saw medical debt decline post-merger, enough to balance the amounts incurred by the newly indebted

Health Effects of Urgent Care Center Entry: The Case of Wellnow

Eliane Barker
,
Hamilton College
Stephen Wu
,
Hamilton College

Abstract

This paper uses multiple sources of data to study the effect of the entry of WellNow urgent care centers (UCC) in New York State on individual health outcomes and health care access. Using a staggered difference-in-differences approach, we show that the opening of a new urgent care center leads to better self-assessed health for individuals living in that particular county. We also find evidence of a decreased strain on the local healthcare system, as the opening of a nearby WellNow facility leads to shorter hospital waiting times and increased likelihood that individuals have a timely routine checkup

The Impact of Hospital Closures on Medical Debt in Collections: Analysis Using Consumer Credit Bureau Data

Jennifer Andre
,
The Urban Institute
Fredric Blavin
,
The Urban Institute
Breno Braga
,
The Urban Institute
Anuj Gangopadhyaya
,
The Urban Institute

Abstract

This study presents new evidence on the potential detrimental effects of hospital closures. We examine how hospital closures affect the likelihood of incurring medical debt. Hospital closures can increase market concentration by removing a competitor from the market. Closures can also have negative spillover effects on the local economy and affect the population’s ability to pay their bills. We combine 2011-2020 consumer credit bureau data with information on hospital closures from 2014-2018 to assess the relationship between closures and medical debt. Using a stacked event study approach, we find that a closure that reduces hospital supply in a Hospital Referral Region (HRR) by 10 percent is associated with a 4 percent increase in the share of consumers with medical debt, with larger effects in HRRs that are urban and have higher rates of poverty. Moreover, we find that a hospital closure is associated with about a 6-8 percent increase in hospital market concentration. These findings suggest that the primary mechanism through which hospital closures affect medical debt is by reducing hospital competition in local markets.

Discussant(s)
Eliane Barker
,
Hamilton College
Marshall Steinbaum
,
University of Utah
Anuj Gangopadhyaya
,
The Urban Institute
JEL Classifications
  • I1 - Health
  • L1 - Market Structure, Firm Strategy, and Market Performance