Title: Essays on information, competition and quality in health care provider markets
Description: This dissertation explores the impact of information and competition on the market for cardiac bypass graft (CABG) surgery in Pennsylvania. In the first chapter, I consider the welfare economics of firm entry when input supply is not perfectly elastic. I assess these predictions empirically by examining the impact of the 1996 repeal of certificate-of-need (CON) legislation in Pennsylvania. Increased entry led to a redistribution of surgeries from lower- to higher-quality surgeons. The value of the improved outcomes due to this redistribution was roughly equal to the additional fixed costs incurred by new entrants. In the second chapter, I consider the impact of quality "report cards" when performance data alters both surgeons' pecuniary incentives (i.e. extrinsic motivation) and incentives unrelated to profit (i.e. intrinsic motivation). Extrinsic incentives due to quality reporting led to a .09 percentage point (three percent) decline in mortality. Consistent with a mixed model of objectives, information on performance that was new to surgeons and unrelated to patient demand led to an intrinsic response three times as large as surgeon response to profit incentives. The third chapter explores the relative roles of privately and publicly provided information in consumer choice of surgeons. I find that market based mechanisms explain about half of the response to quality prior to the release of report cards.