Hospital mergers and antitrust: an economic analysis

The hospital industry has recently experienced substantial merger activity. This paper examines several actual and proposed hospital mergers to determine the extent of competition in the affected markets and the effect these mergers may have on competition. Our focus is on mergers between hospitals in the same market. We define the relevant product and geographic market for hospitals, then develop criteria for evaluating hospital mergers and analyze several merger cases using these criteria. We conclude that these mergers threaten the competition that exists in most of the markets discussed, and that the claimed efficiency justification for mergers is not convincing.     

Legal Consciousness and Responses to Sexual Harassment

Studies of legal mobilization often focus on people who have perceived some wrong, but these studies rarely consider the process that selects them into the pool of potential "mobilizers." Similarly, studies of victimization or targeting rarely go on to consider what people do about the wrong, or why some targets come forward and others remain silent. We here integrate sociolegal, feminist, and criminological theories in a conceptual model that treats experiencing sexual harassment and mobilizing in response as interrelated processes. We then link these two processes by modeling them as jointly determined outcomes and examine their connections using interviews with a subset of our survey respondents. Our results suggest that targets of harassment are selected, in part, because they are least likely to tell others about the experience. We also discuss strategies that workers employ to cope with and confront harassment. We find that traditional formal/informal dichotomies of mobilization responses may not fully account for the range of ways that individuals respond to harassment, and we propose a preliminary typology of responses.     

The economics of emergency response

Federal first responder funding is estimated to be $98 billion below the minimum required level over the 5 years ending in 2010. A significant portion of that shortfall can be covered by savings attained by eliminating non-public-good services, initiating public–private partnerships for meeting peak time demand in emergency situations, and contracting-out other public services. We concentrate on such savings in the context of response to false calls to police, fire, and ambulance services. Solving the false alarm problem for police, fire, and ambulance services and eliminating some non-public-good police services could release significant service-hours and 23.7–31.4% of the required additional Homeland Security (HLS) annual spending. Reducing false alarms means 88,000 police, fire, and ambulance first responders could be shifted to HLS activities.

Hospital mergers: the shift from federal antitrust enforcement to state regulation

The authors examine and analyze the burgeoning merger activity in the hospital arena, as well as the nonfederal attempts made to regulate that activity. They conclude that the present, ad hoc, system of state regulation is sorely wanting and that it would be preferable if stronger antitrust enforcement and judical decisions prevented competition reducing mergers. If a merger results in a true monopoly (and nonetheless passes antitrust scrutiny), its regulation should be the responsibility of the pertinent state public utility board which, unlike the courts and state attorneys general, has sufficient expertise to adequately regulate the merged entities. Otherwise, the faults of the present system, which is easily manipulated by hospitals seeking political and legal cover for their activities, are likely to be perpetuated.     

An Analysis of Policy‐Based Congressional Responses to the U.S. Supreme Court's Constitutional Decisions

While Congress can attempt to overrule constitutional decisions of the Supreme Court by initiating the constitutional amendment process, an amendment is rarely a practicable option. Instead, Congress regularly tries to modify the impact of constitutional decisions with ordinary legislation. I analyze policy‐based responses to the Supreme Court's constitutional decisions that were initiated in Congress between 1995 and 2010. For each responsive proposal, I consider the relationship between the proposed legislation and the Court's legal holding and the relationship between the proposal and the public policy associated with the Court's decision. I find that Congress enjoys considerable success in reversing the policy impacts of the Court's decisions but is limited in its ability to overcome the Court's legal rules.     

Market segmentation in child adoption

The system for the adoption of children is not working well. The dysfunction of the adoption system manifests itself in an excess demand for healthy white babies and excess supply of older children, minority children, or those with disabilities. A market solution can increase the number of adoptions for older children, minority children or children with disabilities. Recognizing the heterogeneity of children and taking account of those differences will yield price differentiation in segmented markets. Such differentiation is especially important in the market for adopted children where the lifetime consequences of a poor match can be severe; more information about child attributes can only improve child-adopter matches. Revenues from the sale of adoption rights for highly demanded children could subsidize the adoption of the less desired children. The time to adoption will decrease and more of the less desired children will be adopted; the sum of consumer (adoptive parents) plus producer (biological mothers or the adoption agencies) surplus will rise and eliminate sub rosa markets for the more desired children.     

Failed hospital mergers

The spate of hospital mergers in recent years has yielded both substantial increases in market power and many divestitures. These seemingly contradictory results stem from the pressures imposed by stakeholders of merging hospitals and the inability of those stakeholders to exert control over nonprofit institutions prior to the effectuation of a merger. This Article examines several recent mergers, analyses their failures, and recommends that the judiciary and state attorneys general look carefully at merging nonprofits so as to fill the void left by the lack of market control mechanisms.