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Cost structure effects of horizontal airline mergers and acquisitions.

ABSTRACT: The purpose of this research is to test the ex-post cost structure effects in horizontal mergers and acquisitions (M&A). Our proposed methodology quantifies cost structure effects empirically to inform competition policy around M&As in the airline industry. The results show that horizontal M&As involving unprofitable firms significantly reduce variable costs and increase fixed costs ex-post. M&As involving only profitable firms show no significant impact on the cost structure. We offer support that the ex-post cost structure effects of airline M&As depend on the incentives to improve efficiency, reflected in the ex-ante performance of the merging firms. We further argue that market behavior may not just depend on market structure but cost structures too, all of which should be accounted for in antitrust decision making and regulation around airline M&As.

SUBMITTER: Gudmundsson SV

PROVIDER: S-EPMC7449883 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Cost structure effects of horizontal airline mergers and acquisitions.

Gudmundsson Sveinn Vidar SV Merkert Rico R Redondi Renato R

Transport policy 20200827

The purpose of this research is to test the ex-post cost structure effects in horizontal mergers and acquisitions (M&A). Our proposed methodology quantifies cost structure effects empirically to inform competition policy around M&As in the airline industry. The results show that horizontal M&As involving unprofitable firms significantly reduce variable costs and increase fixed costs ex-post. M&As involving only profitable firms show no significant impact on the cost structure. We offer support t ...[more]

PMID: 32868969

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Project description:BACKGROUND:The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited. METHODS:Using Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership. RESULTS:The study sample included 246 acquired hospitals and 1986 control hospitals. Being acquired was associated with a modest differential decline in performance on the patient-experience measure (adjusted differential change, -0.17 SD; 95% confidence interval [CI], -0.26 to -0.07; P = 0.002; the change was analogous to a fall from the 50th to the 41st percentile) and no significant differential change in 30-day readmission rates (-0.10 percentage points; 95% CI, -0.53 to 0.34; P = 0.72) or in 30-day mortality (-0.03 percentage points; 95% CI, -0.20 to 0.14; P = 0.72). Acquired hospitals had a significant differential improvement in performance on the clinical-process measure (0.22 SD; 95% CI, 0.05 to 0.38; P = 0.03), but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition. CONCLUSIONS:Hospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive. (Funded by the Agency for Healthcare Research and Quality.).

Project description:ImportanceRural hospitals are increasingly merging with other hospitals. The associations of hospital mergers with quality of care need further investigation.ObjectivesTo examine changes in quality of care for patients at rural hospitals that merged compared with those that remained independent.Design, setting, and participantsIn this case-control study, mergers at community nonrehabilitation hospitals in Federal Office of Rural Health Policy-eligible zip codes during 2009 to 2016 in 32 states were identified from Irving Levin Associates and the American Hospital Association Annual Survey. Outcomes for inpatient stays for select conditions and elective procedures were derived from the Healthcare Cost and Utilization Project State Inpatient Databases. Difference-in-differences linear probability models were used to assess premerger to postmerger changes in outcomes for patients discharged from merged vs comparison hospitals that remained independent. Data were analyzed from February to December 2020.ExposuresHospital mergers.Main outcomes and measuresThe main outcome was in-hospital mortality among patients admitted for acute myocardial infarction (AMI), heart failure, stroke, gastrointestinal hemorrhage, hip fracture, or pneumonia, as well as complications during stays for elective surgeries.ResultsA total of 172 merged hospitals and 266 comparison hospitals were analyzed. After matching, baseline patient characteristics were similar for 303 747 medical stays and 175 970 surgical stays at merged hospitals and 461 092 medical stays and 278 070 surgical stays at comparison hospitals. In-hospital mortality among AMI stays decreased from premerger to postmerger at merged hospitals (9.4% to 5.0%) and comparison hospitals (7.9% to 6.3%). Adjusting for patient, hospital, and community characteristics, the decrease in in-hospital mortality among AMI stays 1 year postmerger was 1.755 (95% CI, -2.825 to -0.685) percentage points greater at merged hospitals than at comparison hospitals (P < .001). This finding held up to 4 years postmerger (DID, -2.039 [95% CI, -3.388 to -0.691] percentage points; P = .003). Greater premerger to postmerger decreases in mortality at merged vs comparison hospitals were also observed at 5 years postmerger among stays for heart failure (DID, -0.756 [95% CI, -1.448 to -0.064] percentage points; P = .03), stroke (DID, -1.667 [95% CI, -3.050 to -0.283] percentage points; P = .02), and pneumonia (DID, -0.862 [95% CI, -1.681 to -0.042] percentage points; P = .04).Conclusions and relevanceThese findings suggest that rural hospital mergers were associated with better mortality outcomes for AMI and several other conditions. This finding is important to enhancing rural health care and reducing urban-rural disparities in quality of care.

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Cost structure effects of horizontal airline mergers and acquisitions.

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Cost structure effects of horizontal airline mergers and acquisitions.

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