Does Scale of Public Hospitals Affect Bargaining Power? Evidence From Japan

Document Type: Original Article

Authors

1 Graduate School of Media and Governance, Keio University, Kanagawa, Japan

2 Center for Community Medicine, Jichi Medical University, Tochigi, Japan

3 Faculty of Policy Management, Keio University, Kanagawa, Japan

Abstract

Background
Many of public hospitals in Japan have had a deficit for a long time. Japanese local governments have been encouraging public hospitals to use group purchasing of drugs to benefit from the economies of scale, and increase their bargaining power for obtaining discounts in drug purchasing, thus improving their financial situation. In this study, we empirically investigate whether or not the scale of public hospitals actually affects their bargaining power.
 
Methods
Using micro-level panel data on public hospitals, we examine the effect of the scale of public hospitals (in terms of the number of occupancy beds) on drug purchasing efficiency (DPE) (the average discount rate in purchasing drugs) as a proxy variable of the bargaining power. Additionally, we evaluate the effect of the presence or absence of management responsibility in public hospital for economic efficiency as the proxy variable of an economic incentive and its interaction with the hospital scales on the bargaining power. In the estimations, we use the fixed effects model to control the heterogeneity of each hospital in order to estimate reliable parameters.
 
Results
The scale of public hospitals does not positively correlate with bargaining power, whereas the management responsibility for economic efficiency does. Additionally, scale does not interact with management responsibility.
 
Conclusion
Giving management responsibility for economic efficiency to public hospitals is a more reliable way of gaining bargaining power in drug purchasing, rather than promoting the increase in scale of these public hospitals.

Keywords

Main Subjects


  1. Hori M. The role of public hospital in Japanese health care providing system. Government Auditing Review. 2007;36:61-76.
  2. Tomi City Office. The Reform Plan of Tomi Municipal Hospital. http://hospital.city.tomi.nagano.jp/simin/kaikakuplan-gaiyo.pdf.  Accessed May 1, 2016. Published 2009.
  3. Kyotango City Office. The Reform Plan of Kyotango City Riyasaka Hospital. http://www.city.kyotango.lg.jp/cms/shisei/singikai/kekka/iryokaikakukaizen/documents/1304.pdf.  Accessed May 1, 2016. Published 2008.
  4. Otsuki City Office. The Reform Plan of Otsuki City National Health Insurance Hospital. http://www.town.taiki.hokkaido.jp/soshiki/byouin/sonota.data/kaikakuplan.pdf.  Accessed May 1, 2016. Published 2009.
  5. Local Government of Saitama Prefecture. The Reform Plan of Saitama Cancer Center. http://www.soumu.go.jp/main_sosiki/c-zaisei/hospital/pdf/saitama_h21/saitama090525_02.pdf.   Accessed May 1, 2016. Published 2009.
  6. Nayoro City Office. New Reform Plan of Nayoro City Hospitals Management. https://www.nayoroch.jp/hotnews/files/00000300/00000366/kaikaku2016-6-2.pdf.  Accessed May 1, 2016. Published 2016.
  7. Galbraith JK. American Capitalism: The Concept of Countervailing Power. New Brunswick: Transaction Publishers; 1993.
  8. Snyder CM. A Dynamic Theory of Countervailing Power. Rand J Econ. 1996;27(4):747-769.
  9. Snyder CM. Why do larger buyers pay lower prices? Intense supplier competition. Econ Lett. 1998;58(2):205-209. doi:10.1016/S0165-1765(97)00279-6
  10. Adilov N, Alexander PJ. Horizontal merger: Pivotal buyers and bargaining power. Econ Lett. 2006;91(3):307-311. doi:10.1016/j.econlet.2005.09.008
  11. Inderst R, Wey C. Buyer power and supplier incentives. Eur Econ Rev. 2007;51(3):647-667. doi:10.1016/j.euroecorev.2006.02.002
  12. Hans-Theo N, Bradley JR, Christopher MS. Do Buyer-Size Discounts Depend on the Curvature of the Surplus Function? Experimental Tests of Bargaining Models. EconWPA; 2003.
  13. Ellison SF, Snyder CM. Countervailing power in wholesale pharmaceuticals. J Ind Econ. 2010;58(1):32-53. doi:10.1111/j.1467-6451.2010.00408.x
  14. Ruffle BJ. When do large buyers pay less? Experimental evidence. J Ind Econ. 2013;61(1):108-137. doi:10.1111/joie.12008
  15. Anegawa T. Empirical study of the demand and price of pharmaceutic als: a case of pharmaceuticals for cardiovascular system. Iryo To Shakai. 1999;9(2):1-17. doi: 10.4091/iken1991.9.2_1
  16. Anegawa T. Price regulation and demand for pharmaceuticals reconsidered:      a case of pharmaceutical fsor cardiovascular System. Iryo To Shakai. 2002;11(3):1-18. doi:10.4091/iken1991.11.3_1
  17. Onda M, Sato M. Official Price Tariff and Demand of Pharmaceuticals. Japanese Journal of Health Economic and Policy. 2002;12:5-28.
  18. Seiritsu O, Takehiko H. Why Do the Japanese Spend So Much on Drugs? National Bureau of Economic Research, Inc; 2003:229-266.
  19. Iizuka T. Generic entry in a regulated pharmaceutical market. Japanese Economic Review. 2009;60(1):63-81. doi:10.1111/j.1468-5876.2008.00465.x
  20. Inoue T, Tezuka K. An analysis of the medical supplies distribution system in Japan. Journal of Business and Management. 1998(2):82-91.
  21. Inoue T, Tezuka K. An empirical study of the medical supplies distribution system in Japan. Japanese Journal of Health Economic and Policy. 2002;11:5-21.
  22. Tanno T, Hayashi Y. Bargaining power and NHI drug price standard in ethical pharmaceutical distribution. Stud Appl Econ. 2014;8:115-127.
  23. Japan Fair Trade Commission. Report on the Distribution of Prescription Drugs (Iryoyouiyakuhin no ryutsujittaini kansuru chousahoukokusho). http://www.jftc.go.jp/houdou/pressrelease/cyosa/cyosa-ryutsu/h18/06092702.files/06092702-hontai.pdf.  Accessed May 1, 2016. Published 2006.
  24. Ministry of Internal Affairs and Communications. Yearbook of Local Public Enterprise. http://www.soumu.go.jp/main_sosiki/c-zaisei/kouei_kessan.html.  Accessed May 1, 2016.
  25. Ministry of Health, Labour and Welfare. Time Series of Average Drug Purchasing Efficiency  (KAIRIRITSU). http://www.mhlw.go.jp/file/05-Shingikai-12404000-Hokenkyoku-Iryouka/0000057384.pdf.  Accessed May 1, 2016.
  26. Choi I. Unit root tests for panel data. J Int Money Finance. 2001;20(2):249-272.
  27. Baltagi BH. Econometric Analysis of Panel Data. 5th ed. Wiley; 2010.
  28. Wooldridge JM. Econometric Analysis of Cross Section and Panel Data. 2nd ed. MIT Press; 2010.
  29. Newhouse JP. Frontier estimation: How useful a tool for health economics? J Health Econ. 1994;13(3):317-322. doi:10.1016/0167-6296(94)90030-2
  30. Kawaguchi H. Study on Estimation of the Efficiency of Municipal Hospitals Using Panel Data (Panerudata womochiita jichitai byōin no kōritsusei no suitei ni kansuru kenkyū). Health efficiency measurement :the methods and problems (iryō no kōritsuseisokutei - sono shuhō to mondaiten). Published2008.