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Rising health care costs and consequent increases in Medicare reimbursements have led to many payment reforms over the years. Implementation of the prospective payment system (PPS) for hospitals in 1983 incentivized hospitals to either purchase skilled nursing facilities (SNFs) or utilize their excess capacity to establish one within the hospital. With PPS reimbursement being applied to SNFs in 1998, prior monetary incentives for hospitals to own an SNF disappeared. However, despite the reduction in numbers, many hospitals continued to operate their hospital-based skilled nursing facilities (HBSNFs).
This study examines the organizational and market-level factors associated with the survival of HBSNFs using the population ecology of organizations framework.
Using American Hospital Association survey data, event histories of all U.S. acute care hospitals with an open HBSNF in 1998 were plotted to examine if a hospital closed its HBSNF during a 22-year period (1998-2020). The primary independent variables included hospital size, ownership, total margin, market competition, and Medicare Advantage penetration. The independent and control variables were lagged by 1 year. Cox regressions were conducted to estimate the hazard ratios capturing the risk of HBSNF closure.
The results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving.
The HBSNF administrators of small, for-profit hospitals and those operating in highly competitive markets could utilize the findings of this study to judiciously allocate slack resources to their HBSNFs to keep those open given the current emphasis on continuity of care by regulatory bodies.

As the Competition and Markets Authority investigation into veterinary services for household pets presses ahead at pace, we continue to champion your interests and promote the value of veterinary care.

BACKGROUND: In many tax-based healthcare systems, policymakers have introduced reforms that promote provider competition with the intention of improving the quality and efficiency. Healthcare competition is usually defined spatially, with local markets often being identified as a circle around each provider. We argue that existing local market definitions can be improved to better capture actual local markets. For pro-competition reforms to potentially lead to the gains envisioned by policymakers, a crucial condition is the actual emergence of competitive markets. However, limited research has been conducted on competition in primary care markets, despite primary care constituting a vital part of a healthcare system.
OBJECTIVE: The study aims to contribute to the debate on how to define local markets geographically and to examine provider competition in Swedish primary care.
METHODS: A cross-sectional study was conducted using data on all individuals and all primary care providers in Sweden. Local markets were defined as: fixed radius (1 km and 3 km); variable radius; and variable shape-our new local market definition that allows markets to vary in both size and shape. Competition was measured using the Herfindahl-Hirschman index and a count of the number of competitors within the local market.
RESULTS: Fixed radius markets fail to capture variation within and across geographical areas. The variable radius and variable shape markets are similar but do not always identify the same competitors or level of competition. Furthermore, competition levels vary significantly in Swedish primary care. Many providers operate in monopoly markets, whereas others face high competition.
CONCLUSIONS: While the variable shape approach has the potential to better capture actual markets and more accurately identify competitors, further analyses are needed. Moreover, Swedish policymakers are advised to decide whether to still pursue competition and if so, take measures to improve local market conditions in monopolies.

BACKGROUND: Originator drug manufacturers use several strategies to delay generic competition in the USA, but it remains unclear whether this results in longer market exclusivity compared to other countries.
OBJECTIVE: We sought to understand how drug market exclusivity lengths vary between the USA and two comparable countries.
METHODS: We focused on drugs approved within 2 years of each other in the USA, France, and Australia from 1995 to 2005, and we compared the lengths of exclusivity from marketing approval through first generic competition or June 2023 using Kaplan-Meier analyses.
RESULTS: Among 165 drugs in common between the USA and France, the median length of exclusivity was slightly longer in France (15.0 years, interquartile range [IQR]: 13.0-19.6) than the USA (14.5 years, IQR: 11.7-17.6). Among 100 drugs in common between the USA and Australia, the median length of exclusivity was longer in Australia (16.3 years, IQR: 13.9-22.4) than in the USA (14.4 years, IQR: 12.0-17.1).
CONCLUSIONS: Market exclusivity lengths in the USA are not longer than in France and Australia. Potential reasons include the larger US market and incentives that offer transient high generic drug prices in the USA for manufacturers that successfully challenge originator market exclusivity.

Anna Judson reports on BVA\'s recent activities around the Competition and Markets Authority\'s market investigation.

OBJECTIVE: In this article, we estimate the initial and temporal impacts of generic entry on benchmark drug prices as reimbursed through the Pharmaceutical Benefits Scheme of Australia and the degree to which further generic competition affects these prices under the current regulatory framework.
METHODS: We construct a panel data set consisting of 781 Pharmaceutical Benefits Scheme listed drugs over a 95-month time period and use fixed-effect regressions. The dynamic price effects of generic competition are investigated by implementing panel methods.
RESULTS: Our results suggest that generic entry into the Australian pharmaceutical market causes significant initial price reductions of approximately 31% and that successive generic entrants also act to further reduce drug prices. Through subgroup analyses, we identify that the effect of generic competition varies significantly according to the drug\'s therapeutic group and mode of drug administration and the dynamic analysis indicates that generic entry results in continuous price reductions even after large initial drops.
CONCLUSIONS: Generic competition reduces reimbursed drug prices in Australia to a greater extent than previous research has identified, although the average price effects can vary significantly depending on a drug\'s therapeutic group or mode of drug administration. Prices generally continue to fall significantly over time under the price disclosure mechanism.

In the current knowledge-based economy, the abilities of the national research system are a key driver of the country\'s competitiveness and socio-economic development. This paper compares the scientific standing of the OECD countries and eight other relevant economies. We use a bibliometric indicator of research performance, applied first at the individual level. This approach avoids the distortions of the aggregate-level analyses extant in literature and practice, which overlook the different publication intensities across research fields. We find a strong correlation between research performance and the economic competitiveness of nations and a moderate but significant correlation between research performance and the propensity to spend on research.

The increasingly prominent issue of unfair competition on Internet platforms (IPUC) severely restricts the healthy and sustainable development of the platform economy. Based on the IPUC \"multi-agent co-governance\" scenario, this paper introduces stochastic disturbances and continuous strategy set to improve the classical binary deterministic evolutionary game system. The results show that after considering stochastic disturbances, the positive state corresponding to the equilibrium point (1,1) is no longer stable, and the required parameter conditions are more stringent. The IPUC \"multi-agent co-governance\" system under stochastic disturbances exhibits specific vulnerability. In the continuous strategy set evolutionary game system, government departments and Internet platforms can flexibly make optimal decisions based on maximizing expected returns, and strategy selection has better elasticity. Regardless of the evolutionary game scenario, maintaining the participation level of NGOs and the public above a certain threshold while increasing the penalty intensity is conducive to the evolution of the game system toward the positive state. The analysis process and conclusions provide insights and guidance for the governments to design the IPUC regulatory system and frameworks.

We examine variation in US hospital quality across ownership, chain membership, and market concentration. We propose a new measure of quality derived from penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program, and use regression models to risk-adjust for hospital characteristics and county demographics. While the overall association between for-profit ownership and quality is negative, there is evidence of substantial heterogeneity. The quality of for-profit relative to non-profit hospitals declines with increasing market concentration. Moreover, the quality gap is primarily driven by for-profit chains. While the competition result mirrors earlier findings in the literature, the chain result appears to be new: it suggests that any potential quality gains afforded by chains are mostly realized by not-for-profit hospitals.