Does competition from ambulatory surgical centers affect hospital surgical output?

Charles Courtemanche, Michael Plotzke

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


This paper estimates the effect of ambulatory surgical centers (ASCs) on hospital surgical volume using hospital and year fixed effects models with several robustness checks. We show that ASC entry only appears to influence a hospital's outpatient surgical volume if the facilities are within a few miles of each other. Even then, the average reduction in hospital volume is only 2-4%, which is not nearly large enough to offset the new procedures performed by an entering ASC. The effect is, however, stronger for large ASCs and the first ASCs to enter a market. Additionally, we find no evidence that entering ASCs reduce a hospital's inpatient surgical volume.

Original languageEnglish
Pages (from-to)765-773
Number of pages9
JournalJournal of Health Economics
Issue number5
StatePublished - Sep 2010

Bibliographical note

Funding Information:
The authors are grateful to the editor, an anonymous referee, Donald Nichols, Charles Moul, Chris Ruhm, and audience members at the 2009 AcademyHealth Annual Research Meeting for their valuable comments and suggestions. Finally, we thank Washington University in St. Louis - Olin School of Business and the Center for Research in Economics and Strategy (CRES) and Abt Associates Inc. for their financial support. All errors are our own.


  • Ambulatory surgical center
  • Hospital competition
  • Hospital profit
  • Physician-ownership

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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