The newly launched Health Care Affordability Lab within New Haven, Conn.-based Yale University’s Tobin Center for Economic Policy released a tool March 9 that allows users to explore hospital mergers, closures, ownership changes and market concentration across all 50 states.
Using the dataset behind the lab’s new Hospital Markets data visualization tool, researchers analyzed the share of hospitals in each state operating in a highly concentrated or monopoly market as measured by the Herfindahl–Hirschman Index, a standard antitrust measure of market concentration.
The dataset includes general, short-term acute-care hospitals and excludes specialty hospitals, long-term care facilities and VA or military hospitals.
In the tool, a hospital’s “market” is defined using a 30-minute travel radius around each facility. Hospital markets can be highly concentrated in both rural and urban areas, but rural areas face particular challenges maintaining competitive markets.
The Herfindahl–Hirschman Index ranges from zero, denoting many small competitors, to 10,000, denoting a monopoly. Markets with HHIs between 5,000 and less than 10,000 are considered highly concentrated, while markets with HHIs above 10,000 are considered monopolies.
Researchers totaled the number of hospitals in highly concentrated and monopoly markets in each state and divided that by the state’s total number of hospitals to determine the percent of hospitals operating in highly concentrated or monopoly markets.
Here are the 50 states ranked by the percent of hospitals located in highly concentrated or monopoly markets.
More information on the dataset and methodology is available here.
1. North Dakota — 100.0%
2. South Dakota — 100.0%
3. Wyoming — 100.0%
4. Montana — 98.4%
5. Maine — 97.4%
6. West Virginia — 87.2%
7. Vermont — 86.7%
8. Idaho — 86.0%
9. Alaska — 85.7%
10. New Mexico — 76.1%
11. Oregon — 71.7%
12. North Carolina — 71.2%
13. Arkansas — 68.1%
14. South Carolina — 67.7%
15. Colorado — 66.7%
16. Delaware — 66.7%
17. Hawaii — 66.7%
18. Alabama — 66.3%
19. Washington — 66.3%
20. Georgia — 61.7%
21. Utah — 61.7%
22. Virginia — 60.5%
23. Iowa — 59.7%
24. Kansas — 56.5%
25. Oklahoma — 56.2%
26. Kentucky — 55.7%
27. New Hampshire — 55.6%
28. Tennessee — 54.8%
29. Missouri — 54.2%
30. Mississippi — 53.8%
31. Minnesota — 52.8%
32. Pennsylvania — 50.0%
33. Indiana — 47.8%
34. Nebraska — 47.7%
35. Michigan — 47.4%
36. Arizona — 45.5%
37. Louisiana — 43.1%
38. Connecticut — 40.6%
39. Wisconsin — 40.6%
40. New York — 39.9%
41. Texas — 38.8%
42. Florida — 38.2%
43. Nevada — 38.2%
44. Illinois — 37.9%
45. Ohio — 33.8%
46. Massachusetts — 31.9%
47. Maryland — 30.2%
48. California — 26.8%
49. New Jersey — 21.1%
50. Rhode Island — 8.3%
51. District of Columbia — 0.0%
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