Assessing the potential of collaborative innovation strategies to drive green development: Threshold effect of market competition.

Environmental management literature suggests that elevating the total factor productivity (TFP) of the renewable energy (RE) industry is pivotal for achieving green development. With intensifying market competition in the RE sector, collaborative innovation (COI) has emerged as a crucial strategic choice for enterprises to address developmental bottlenecks. To assess the potential of COI in driving green development, we leveraged data from 114 Chinese RE enterprises from 2011 to 2022. The research findings indicate: (1) COI significantly enhances the TFP of RE enterprises; this enhancement primarily stems from the positive influence of COI on innovation capabilities. (2) The positive effects of COI on TFP manifest only when market competition surpasses a certain threshold level. (3) COI significantly impacts the TFP of small and medium-sized RE enterprises in the growth stage.

Market competition influences practice patterns in management of patients with intermittent claudication in the vascular quality initiative.

OBJECTIVE: The Society for Vascular Surgery (SVS) clinical practice guidelines recommend best medical therapy (BMT) as first-line therapy before offering revascularization to patients with intermittent claudication (IC). Notably, atherectomy and tibial-level interventions are generally discouraged for management of IC; however, high regional market competition may incentivize physicians to treat patients outside the scope of guideline-directed therapy. Therefore, we sought to determine the association between regional market competition and endovascular treatment of patients with IC. METHODS: We examined patients with IC undergoing index endovascular peripheral vascular interventions (PVI) in the SVS Vascular Quality Initiative from 2010 to 2022. We assigned the Herfindahl-Hirschman Index as a measure of regional market competition and stratified centers into very high competition (VHC), high competition, moderate competition, and low competition cohorts. We defined BMT as preoperative documentation of being on antiplatelet medication, statin, nonsmoking status, and a recorded ankle-brachial index. We used logistic regression to evaluate the association of market competition with patient and procedural characteristics. A sensitivity analysis was performed in patients with isolated femoropopliteal disease matched by the TransAtlantic InterSociety classification of disease severity. RESULTS: There were 24,669 PVIs that met the inclusion criteria. Patients with IC undergoing PVI were more likely to be on BMT when treated in higher market competition centers (odds ratio [OR], 1.07 per increase in competition quartile; 95% confidence interval [CI], 1.04-1.11; P < .0001). The probability of undergoing aortoiliac interventions decreased with increasing competition (OR, 0.84; 95% CI, 0.81-0.87; P < .0001), but there were higher odds of receiving tibial (OR, 1.40; 95% CI, 1.30-1.50; P < .0001) and multilevel interventions in VHC vs low competition centers (femoral + tibial OR, 1.10; 95% CI, 1.03-1.14; P = .001). Stenting decreased as competition increased (OR, 0.89; 95% CI, 0.87-0.92; P < .0001), whereas exposure to atherectomy increased with higher market competition (OR, 1.15; 95% CI, 1.11-1.19; P < .0001). When assessing patients undergoing single-artery femoropopliteal intervention for TransAtlantic InterSociety A or B lesions to account for disease severity, the odds of undergoing either balloon angioplasty (OR, 0.72; 95% CI, 0.625-0.840; P < .0001) or stenting only (OR, 0.84; 95% CI, 0.727-0.966; P < .0001) were lower in VHC centers. Similarly, the likelihood of receiving atherectomy remained significantly higher in VHC centers (OR, 1.6; 95% CI, 1.36-1.84; P < .0001). CONCLUSIONS: High market competition was associated with more procedures among patients with claudication that are not consistent with guideline-directed therapy per the SVS clinical practice guidelines, including atherectomy and tibial-level interventions. This analysis demonstrates the susceptibility of care delivery to regional market competition and signifies a novel and undefined driver of PVI variation among patients with claudication.

Entry and competition of retail pharmacies: A case study of OTC drugs sales and ownership deregulation1.

This study provides new empirical evidence on the changes in competition and entry decisions of pharmacies after regulatory changes. It investigates the development of the retail pharmacy market in Portugal, which underwent major regulatory changes in 2004 and 2007. Sale of OTC drugs and ownership of pharmacies were liberalized while entry restrictions related to market size and the location of new pharmacies prevailed. Our empirical strategy was based on entry models and provided indirect information on the toughness of competition and entry decisions of firms in the market. We estimated and compared the entry thresholds and their ratios before and after liberalization. Such a comparison allows to see if competition got tenser with OTC drugs deregulated. There were three main findings from the study. First, the entry thresholds decreased regardless of the number of pharmacies in the market, suggesting that room for the realization of profits is broader than it was in the past. Second, although the entry thresholds were lower in value, their increase was steeper with each incumbent in 2020, suggesting harsher price competition with new entrants. Third, the current rule of 3,500 patients per pharmacy is likely overly restrictive, pharmacies could break-even even in smaller markets.

The impact of price transparency and competition on hospital costs: a research on all-payer claims databases.

BACKGROUND: Public reporting has been considered effective in reducing health care costs by mitigating information asymmetry in the market as payers have incorporated publicly available information mandates into pay-for-performance programs and value-based purchasing. Therefore, hospitals have faced increasing pressures to provide price transparency. Despite the widespread promotion of healthcare transparency, the effectiveness of public reporting has not yet been sufficiently understood. This study analyzed the impact of transparency policy and competition on hospital costs by taking the state operations of all-payer claims databases (APCDs) as a case of interest. METHODS: We employed a fixed-effects regression, which allows the generation of hospital-specific effects, in accordance with the suggestion by the Hausman test. The study samples comprise nonprofit and for-profit general acute care hospitals in the United States for 2011-2017. The finalized dataset ranges from 3547 observations in 2011 to 3405 observations in 2015 after removing missing values. RESULTS: We found that hospitals in the states with APCDs tend to bear higher average operating expenses than those without APCDs, which may indicate that states maintaining higher healthcare expenditures are more attentive to a price transparency initiative and tend to adopt APCDs. With regard to competition, the results showed that weak market competition is significantly associated with higher operating costs, supporting the traditional competition theory. However, the combined effect of APCDs and competition did not indicate a significant association with operating expenses. Further investigation showed a continued tendency for a weak intensity of competition to be linked to lower hospital operating costs in states without APCDs. For those located in non-APCD adopted states, market consolidation helped hospitals coordinate care more effectively, economize operating costs, and enjoy economies of scale due to their large size. Similar trends did not appear in APCD-adopted states except for in 2015. CONCLUSIONS: This study observed limited evidence of the impact of APCDs and market competition. Our findings suggest that states need to make multifaceted efforts to contain hospital costs, not solely depending on the rollout of cost information or market competition. Market concentration may lead to coordinated care or cost economization in some cases. Still, the existing literature also demonstrates some potentially harmful impacts of increased concentration in the healthcare market, such as inefficient use of resources, unilateral market power, and deterrence of innovation. The introduction of a price transparency tool may require additional policy actions that take market competition into consideration.

Does hospital competition lead to medical equipment expansion? Evidence on the medical arms race.

With the implementation of a series of pro-competition policies in China, the hospital market competition has been intensified dramatically over the past decade. Based on previous literature, such competition is very much likely to bring about an upgoing trend in the promotion and expansion of medical facilities among hospitals as an essential strategy for attracting patients, which is known as Medical Arms Race (MAR). Comprehensive evaluations have been conducted by previous studies on the consequences of the MAR, which, however, merely provided inadequate empirical evidence on the relationship between hospital competition and MAR. Utilizing the variations in hospital competition across various regions and through different time periods in Sichuan Province as a prototype representative of the nationwide situation, a dynamic panel data model was established and adopted in this study for investigating whether intensified hospital competition had resulted in the expansion of medical facilities in China during the corresponding time period. The geopolitical boundaries and Herfindahl-Hirschman Index (HHI) were respectively employed to define the hospital market and measure the competition degree. We found that a 10% reduction in HHI is associated with an 8.79% increase in regional total costs of advanced medical equipment per capita, suggesting that hospital competition would lead to medical equipment expansion. Our results provide novel evidence on MAR which is particularly applicable for the healthcare system in China, providing suggestions for nationwide healthcare reform in order to mitigate potential negative outcomes induced by the implementation of pro-competition policies.

Labour market competition for public health graduates in the United States: A comparison of workforce taxonomies with job postings before and during the COVID-19 pandemic.

A strong public health workforce (PHW) is needed to respond to COVID-19 and public health (PH) issues worldwide. However, classifying, enumerating, and planning the PHW is challenging. Existing PHW taxonomies and enumerations focus on the existing workforce, and largely ignore workforce competition for public health graduates (PHGs). Such efforts also do not utilize real time data to assess rapid changes to the employment landscape, like those caused by COVID-19. A job postings analysis can inform workforce planning and educational program design alike. To identify occupations and industries currently seeking PHGs and contrast them with existing taxonomies, authors matched existing PHW taxonomies to standardized occupational classification codes, then compared this with 38,533 coded, US job postings from employers seeking Master's level PHGs from 1 July 2019 to 30 June 2020. Authors also analysed 24,516 postings from March 2019 to October 2019 and compared them with 24,845 postings from March 2020 to October 2020 to assess changing employer demands associated with COVID-19. We also performed schema matching to align various occupational classification systems. Job postings pre-COVID and during COVID show considerable but changing demand for PHGs in the US, with 16%-28% of postings outside existing PHW taxonomies, suggesting labour market competition which may compound PHW recruitment and retention challenges.

Labor Market Segmentation and Immigrant Competition: A Quantal Response Statistical Equilibrium Analysis.

Competition between and within groups of workers takes place in labor markets that are segmented along various, often unobservable dimensions. This paper proposes a measure of the intensity of competition in labor markets on the basis of limited data. The maximum entropy principle is used to make inferences about the unobserved mobility decisions of workers in US household data. The quantal response statistical equilibrium class of models can be seen to give robust microfoundations to the persistent patterns of wage inequality. An application to labor market competition between native and foreign-born workers in the United States shows that this class of models captures a substantial proportion of the informational content of observed wage distributions.

Higher tourism specialization, better hotel industry efficiency?

This study examines the effects of both specialization in tourism and market competition on the efficiency of the hotel industry. For this purpose, stochastic frontier analysis (SFA) was employed to evaluate the efficiency of the hotel industry on a provincial level in China and to analyze how it is impacted by specialization in tourism and market competition. The results confirm that tourism specialization and market competition exert a synergistic effect on hotel industry efficiency in China. This study finds that tourism development as represented by a high level of tourism specialization by a destination does not guarantee high efficiency in hotels but does enhance the negative effect of market competition on hotel industry efficiency. Significant policy and managerial implications stem from these findings.

Market Consolidation and Mortality in Patients Initiating Hemodialysis.

BACKGROUND: It is uncertain whether consolidation in health care markets affects the quality of care provided and health outcomes. OBJECTIVES: To examine whether changes in market competition resulting from acquisitions by two large national for-profit dialysis chains were associated with patient mortality. METHODS: We identified patients initiating in-center hemodialysis between 2001 and 2009 from a registry of patients with end-stage renal disease in the United States. We considered two scenarios when evaluating consolidation from dialysis facility acquisitions: one in which we considered only those patients receiving dialysis in markets that became substantially more concentrated to have been affected by consolidation, and the other in which all patients living in hospital service areas where a facility was acquired were potentially affected. We used a difference-in-differences study design to examine the associations between market consolidation and changes in mortality rates. RESULTS: When we considered the 12,065 patients living in areas that became substantially more consolidated to have been affected by consolidation, we found a nominally significant (8%; 95% confidence interval 0%-17%) increase in likelihood of death after consolidation. Nevertheless, when we considered all 186,158 patients living in areas where an acquisition occurred to have been affected by consolidation, there was no observable effect of market consolidation on mortality. CONCLUSIONS: Decreased market competition may have led to increased mortality among a relatively small subset of patients initiating in-center hemodialysis in areas that became substantially more concentrated after two large dialysis acquisitions, but not for most of the patients living in affected areas.

Hospitals accreditation status in Indonesia: associated with hospital characteristics, market competition intensity, and hospital performance?

BACKGROUND: Hospital accreditation is widely adopted as a visible measure of an organisation's quality and safety management standards compliance. There is still inconsistent evidence regarding the influence of hospital accreditation on hospital performance, with limited studies in developing countries. This study aims to explore the association of hospital characteristics and market competition with hospital accreditation status and to investigate whether accreditation status differentiate hospital performance. METHODS: East Java Province, with a total 346 hospitals was selected for this study. Hospital characteristics (size, specialty, ownership) and performance indicator (bed occupancy rate, turnover interval, average length of stay, gross mortality rate, and net mortality rate) were retrieved from national hospital database while hospital accreditation status were recorded based on hospital accreditation report. Market density, Herfindahl-Hirschman index (HHI), and hospitals relative size as competition indicators were calculated based on the provincial statistical report data. Logistic regression, Mann-Whitney U-test, and one sample t-test were used to analyse the data. RESULTS: A total of 217 (62.7%) hospitals were accredited. Hospital size and ownership were significantly associated with of accreditation status. When compared to government-owned, hospital managed by ministry of defense (B = 1.705, p = 0.012) has higher probability to be accredited. Though not statistically significant, accredited hospitals had higher utility and efficiency indicators, as well as higher mortality. CONCLUSIONS: Hospital with higher size and managed by government have higher probability to be accredited independent to its specialty and the intensity of market competition. Higher utility and mortality in accredited hospitals needs further investigation.

How did market competition affect outpatient utilization under the diagnosis-related group-based payment system?

OBJECTIVE: Although competition is known to affect quality of care, less is known about the effects of competition on outpatient health service utilization under the diagnosis-related group payment system. This study aimed to evaluate these effects and assess differences before and after hospitalization in South Korea. DESIGN: Population-based retrospective observational study. SETTING: We used two data set including outpatient data and hospitalization data from National Health Claim data from 2011 to 2014. PARTICIPANTS: Participants who were admitted to the hospital for hemorrhoidectomy were included. A total of 804 884 hospitalizations were included in our analysis. MAIN OUTCOME MEASURE(S): The outcome variables included the costs associated with outpatient examinations and the number of outpatient visits within 30 days before and after hospitalization. RESULTS: High-competition areas were associated with lower pre-surgery examination costs (rate ratio [RR]: 0.88, 95% confidence interval [CI]: 0.88-0.89) and fewer outpatient visits before hospitalization (RR: 0.98, 95% CI: 0.98-0.99) as well as after hospitalization compared with moderate-competition areas. CONCLUSION: Our study reveals that outpatient health service utilization is affected by the degree of market competition. Future evaluations of hospital performance should consider external factors such as market structure and hospital location.

OSTEOPOROSIS DRUGS MARKETED IN THE UNITED STATES: GENERIC COMPETITION, PRICING STRUCTURE, AND DISPERSION AMONG PAYERS.

BACKGROUND: Despite the cost of pharmaceuticals, studies assessing prices of osteoporosis drugs are lacking. This study examined trends in prices of osteoporosis drugs in the United States in the period 1988-2014, assessed pricing structure of osteoporosis drugs, and evaluated price trends before and after generic drugs market entry. METHODS: Data were derived from the U.S. Food and Drug Administration, the RedBook, the Centers for Medicare & Medicaid Services, and the Federal Supply Schedule (FSS). Descriptive statistics and segmented linear regression analyses were performed. RESULTS: In the period 1988-2014, osteoporosis drug prices increased faster than the inflation. The average wholesale price (AWP) of generic products at market entry represented 90 percent of the AWP for the corresponding brand. Prices of brand products continued to increase after generic entry. Drug prices showed a significant variation when compared with the brand AWP. The brand wholesale acquisition cost (WAC) was typically set at 83.3 percent of the AWP. Community pharmacies acquired osteoporosis brand drugs at a median of 80.5 percent of the brand AWP. Significant reductions in brand AWP were observed for Medicare Part B (78.5 percent of the brand AWP), generic National Average Drug Acquisition Cost (33.7 percent), and FSS (22.5 percent). CONCLUSIONS: There are significant differences in the manufacturer prices, pharmacy acquisition costs and reimbursement rates of osteoporosis drugs. Pharmaceutical companies listed prices are higher than the pharmacy actual estimated acquisitions costs, and the prices used for reimbursement to providers. Generic drugs entry significantly drives down prices; still, prices of branded drugs facing generic competition continued to increase after generic market entry.

Does financialization inhibit enterprise innovation? Analysis of innovation behavior of Chinese enterprises based on evolutionary game.

Enterprise innovation remains a cornerstone of economic development, with the direct influence of financialization on enterprise innovation standing as a critical factor. In contrast with the existing research, this study constructs an evolutionary game model by utilizing the Cournot model to analyze the innovation behavior of enterprises, and analyzes the influence of financialization on enterprise innovation by incorporating investment returns, market competition, and demand scale into the research framework. In addition, this study selects the sample of the Chinese non-financial listed enterprises and using panel data for the period 2009 to 2021. Based on the findings from the empirical analysis, this study reveals that excessive financialization hinders innovation in Chinese enterprises. Additionally, an intermediary pathway involving 'financialization - investment returns - enterprise innovation' is identified as a transmission mechanism. The demand scale generated by innovation inversely correlates with the inhibitory effects of financialization on enterprise innovation behavior. Meanwhile, heightened market competition amplifies the inhibitory influence of financialization on innovation. This study provided valuable empirical evidence, facilitating the enhancement of enterprise innovation efficiency.

How digital finance impacts listed companies' green innovation in China: a product market perspective.

We empirically test whether and how digital finance impact green innovation utilizing data from Chinese listed companies and the Digital Inclusive Finance Index at the city level over the period from 2011 to 2020. The results show the following: (a) digital finance has a positive impact on green innovation, (b) improving consumer demand and strengthening market competition are two important influence channels, (c) customer concentration and corporate social responsibility are two important moderating variables that affect the aforementioned product market mechanisms, and (d) the positive impact of digital finance is more prominent within state-owned enterprises, companies with high financial risks, economically underdeveloped regions, and low-polluting industries. This research provides insights for China and similar economies on how to leverage the significant role of digital finance in achieving their net-zero-carbon targets.

Strategic behavior and entry deterrence by branded drug firms: the case of authorized generic drugs.

Pharmaceutical firms that market brand-name drugs lose substantial market share to generic manufacturers after patent expiration. As a response to the threat of generic competition, branded manufacturers pursue defensive strategies. One such strategy is the launch of authorized generic drugs. Authorized generic drugs are produced by branded manufacturers to compete against other generic drug entrants. Such competition may lower the expected profits of generic drug manufacturers and hence deter future generic drug entry. This paper models and empirically examines whether the introduction of authorized generic drugs changes the independent generic firms' decisions on entering the market. We use an instrumental variable approach to evaluate the effect of authorized generic drugs on the responses of generic manufacturers. The results show that the entry of authorized generic drugs deters and delays the entry of generic drugs.

Variation in tiered network health plan penetration and local provider market characteristics.

OBJECTIVE: To understand variation in enrollment in tiered network health plans (TNPs) and the local provider market characteristics associated with TNP penetration. DATA SOURCES AND STUDY SETTING: We used 2013-2017 Massachusetts three-digit ZIP code level employer-sponsored health insurance enrollment data, data on physician horizontal and vertical affiliations from the Massachusetts Provider Database, state hospital reports in 2013, 2015, and 2017, and the 2013-2017 Massachusetts All-Payer Claims database. STUDY DESIGN: Linear regressions were used to estimate associations between TNP and local provider market characteristics. DATA EXTRACTION: We constructed measures of TNP penetration and local provider market characteristics and linked these data using three-digit ZIP code. PRINCIPAL FINDINGS: TNP penetration was at least 10% in all employer market sectors and highest among jumbo sized employers. All state employee health plan enrollees were in a tiered network health plan. Among enrollees not in the state employee health plan, TNP penetration varied from 6.0% to 19.6% across three-digit ZIP codes in Massachusetts. TNP penetration was higher in areas with less horizontal and vertical physician market concentration. CONCLUSIONS: Market competition, rather than the absolute quantity of physicians in an area, is associated with TNP penetration.

Testing the impact of sustainable environmental regulations on firm performance with mediating effect of product market competition: empirical evidence from Turkey.

Environmental challenges are increasingly becoming global issues due to the negatively induced effect of carbon dioxide on the natural climate and the well-being of human beings. Industrialisation has intensified the energy demand which brought the surge in the consumption of conventional non-renewable energy resources, including fossil fuels. Despite the overwhelming evidence of negative effects of utilising conventional energy on the atmosphere, there has been a steady rise in industrial production which has encouraged firms to adopt technological innovation. In this sense, many countries have developed various strategies, frameworks and regulations to reduce industrial-driven environmental degradation. Environmental-friendly compliant production technology can be an important substitute model to improve economic development. This study examines the relationship between environmental regulation and firm performance with mediating the impact of product market competition in Turkey. The study uses multi-sectoral firm-level Turkish data covering from 2004 to 2020 which was analysed via numerous methods that control for endogeneity bias. The results of generalised method of moment indicate a strong positive effect of sustainable environmental regulation (SER) on firm performance (FP). Moreover, after mediating the effect of product market competition by decomposing the firms into low product market competition (LPMC) and high product market competition (HPMC), finding reveals a negative effect of SER on FP of LMPC whereas a positive impact was found in the HPMC firms. This finding shows that HPMC compels managers to form a differentiated profit maximisation strategy. In this sense, competition can play a dedicated role in enhancing firm performance in the context of government deliberate strategies and regulations for control of the industrial negative effect on the environment. The industrial sector needs to switch from conventional energy practices to sourcing green and renewable energy that would not jeopardise the environmental quality.

Does artificial intelligence kill employment growth: the missing link of corporate AI posture.

Introduction: An intense debate has been on-going about how artificial intelligence (AI) technology investments have an impact on employment. The debate has often focused on the potential of AI for human task automation, omitting the strategic incentive for firms to cooperate with their workers as to exploit AI technologies for the most relevant benefit of new product and service innovation. Method: We calibrate an empirical probit regression model of how changes in employment relate to AI diffusion, based on formalizing a game-theoretical model of a firm exploiting the twin role of AI innovation and AI automation for both absolute and competitive advantage. Results: The theoretical game-theory prediction is that employment following AI technology adoption is not negative, and ultimately depends on how AI leads to new success in innovation, competition which defines the competitive reward of innovation and profit sharing between workers and firms. Our estimation, is based on a global survey of 3,000 large companies across 10 countries, demonstrates that a firm employment growth depends on two strategic postures, that is, the firm relative maturity of AI adoption as well as its relative bias toward AI-based product innovation. Discussion: The contribution of this research is to highlight the twin role of firm and workers in shaping how technology will affect employment. AI in particular marries the potential of task automation with even more potential for expansion.

How does market competition affect supplier-induced demand? An experimental study.

Introduction: This study investigated the impact of competition on supplier-induced demand in medical markets theoretically and experimentally. Methods: We employed the framework of credence goods to describe the information asymmetry between physicians and patients, and theoretically derives predictions of physicians' behaviors in monopolistic and competitive markets. Then we conducted behavioral experiments to empirically test the hypotheses. Results: The theoretical analysis revealed that an honest equilibrium would not exist in a monopolistic market, whereas price competition could induce physicians to reveal their types of treatment cost and provide honest treatments; thus, a competitive equilibrium is superior to that of a monopolistic market. The experimental results only partially supported the theoretical predictions, which showed that the cure rate of patients in a competitive environment was higher than that in a monopolistic market, although supplier-induced demand occurred more frequently. In the experiment, the main channel through which competition improved market efficiency was increased patient consultations through low pricing, as opposed to the theory, which stated that competition would lead to physicians' honest treatment of patients through fair prices. Discussion: We discovered that the divergence between the theory and the experiment stemmed from the theory's reliance on the assumption that humans are rational and self-interested, which means that they are not as price-sensitive as predicted by theory.

Can environmental tax improve the environmental investment? Evidence from a quasi-natural experiment in China.

The implementation of the Environmental Tax Law is a milestone in promoting China's green tax reform. However, the existence literature has lacked attention to whether it leads enterprises to invest in green environmental protection. To examine the Environmental Tax Law effects and mechanism on the environmental investment of heavy-polluted enterprises, this study used the data of heavy-polluted enterprises listed on the A-share market from 2012 to 2020 and regarded the Environmental Tax Law as a quasi-natural experiment to employ a difference-in-differences model. We found that environmental tax improves the green environmental investment of heavy-polluted enterprises, reflecting the guiding role of policy on enterprise investment allocation. Heterogeneity was found, and the promotion effect of environmental tax reform on enterprise environmental investment is more significant in non-nation-owned, central-western regions, and small-scale enterprises. Further analysis believed that market competition, as an external mechanism, helps strengthen environmental tax reform's implementation effect. The findings of this paper provide a new proof for a comprehensive understanding of the micro-effect of environmental tax reform and provide a reference for the implementation of green development strategies.