Research Article 2026-04-23 under-review v1

When a Neighbor Closes: Ownership and Hospital Profits

S
Salpy Kanimian Rice University
S
Shishir Shakya Appalachian State University

Abstract

How nearby hospitals adjust financially after a neighboring closure may depend on ownership incentives, yet existing research has not examined this variation by ownership type. Using publicly available cost report data from the National Academy for State Health Policy Hospital Cost Tool for short-term hospitals from 2011 through 2019, this study compares hospitals with exactly two neighbors within sixty miles that experienced a neighboring closure to those retaining two neighbors, ensuring comparable baseline market structure. For-profit hospitals show the largest post-closure increases in charge-to-cost ratios and net profit margins. Nonprofit hospitals show smaller gains, while governmental hospitals show changes indistinguishable from zero, motivating ownership-differentiated policy responses. JEL: I11, I18, L21

Citation Information

@article{salpykanimian2026,
  title={When a Neighbor Closes: Ownership and Hospital Profits},
  author={Salpy Kanimian and Shishir Shakya},
  journal={Eastern Economic Journal},
  year={2026},
  doi={https://doi.org/10.21203/rs.3.rs-9408963/v1}
}
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