FIVE COMPETITIVE FORCES UPSTREAM MARKETS SUPPLIERS: V Competitive forces E through bargaining R and economic leverage T HOR I ZONTAL RELATIONSHIPS C A PRODUCERS L COMPETITORS: OF SUBSTITUTES: Competitive forces through rivalry of sellers in different markets through price, advertising, lobbying etc. R E L A T I O N S Competitive forces through rivalry of sellers in same market through price, advertising, lobbying etc. POTENTIAL COMPETITORS: Competitive for ce from threat of entry BUYERS: Competitive forces through bargaining and economic leverage DOWNSTREAM MARKETS TYPE OF MARKET PRD DIFF. SELLERS BUYERS MONOPOLY OLIGOPOLY MONOPOLISTIC COMPETITION COMPETITION MONOPSONY OLIGOPSONY BILATERAL MONOPOLY BILATERAL OLIGOPOLY UNIQUE ONE MANY FEW MANY PRD DIFF. MANY MANY STANDARD MANY MANY MANY ONE MANY FEW - ONE ONE FEW FEW ONE FEW ONE FEW TYPE OF MARKET OBJECTIVE P Q PRO- EFFI FIT CIENT MONOPOLY OLIGOPOLY Interdependence MONOPOLISTIC COMPETITION COMPETITION MONOPSONY OLIGOPSONY BILATERAL MONOPOLY BILATERAL OLIGOPOLY S.Run Profit Large Not Mkt. Share Med. Not Horizontal W A R Customer None Exc. Loyalty Cap. Min Cost Lowest HighestNone Yes Min Price Yes Not Min Price Yes Not Max Share ? Vertical of Profit WAR Max Share ? Vertical GENERALIZED DEMAND FUNCTION f = f( Price: Taxes, Price of Complements Price of Substitutes Tastes for good/service Income, Buyer Expectations, Number of buyers) GENERALIZED SUPPLY FUNCTION f = f( Price: Price of Resources Technology, Seller Expectations, Number of Sellers) HOW TO BE SHERLOCK HOLMES IN READING BETWEEN THE LINES If You Know P and Q then you know whether demand or supply is involved as well as the direction of the shift. If You Know the shift in demand or supply, then you know what is likely to happen to price and quantity If You Know the determinant that has changed and price, then you know what is happening to quantity demanded. If You Know the determinant that has changed and quantity demanded, then you know what is happening to price. Lower Price Lower Output Higher Price Leftward (downward) Shift of Demand Leftward (upward) Shift of Supply Higher Output Rightward (downward) Shift of Supply Rightward (upward) Shift of Demand Breakdown all shifts into their output and price vectors Figure 1. Shifts of Supply and Demand (A) (B) SUPPLY SHIFTS: LEFTWARD (up) P Supply Q (C) RIGHTWARD (down) DEMAND SHIFTS: LEFTWARD (down) P P Supply Q (D) RIGHTWARD (up) P Demand Q Demand Q Participants Product (m=many,f=few,1=one) Type of Market SHIFTS OF: Differentiation SELLERS BUYERS (eg. Monopoly, SUPPLY DEMAND competition,etc) Left Right Left Right I=international,N=national, (Y= yes, N=no) R=regional, L=local Seller Markets Buyer Extent: I N R L Seller Buyer Extent: I N R L Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Write down one market Type Circle One of the four possibilities Seller Buyer Extent: I N R L Seller Buyer Extent: I N R L Seller Buyer Extent: I N R L Circle one for each market Circle One Circle One Circle One RULES for VERTICAL DEMAND and SUPPLY SHIFTS Determinants of supply and demand: 1. A higher price of resources shifts the supply curve upward. 2. A lower income of buyers (total revenue if firms are buyers) shifts demand downward. Implications: 1. A demand shift causes a demand shift in the same direction for all upstream markets. 2. A supply shift causes a supply shift in the same direction for all downstream markets. 3. A change in price or quantity in any market translates into supply shifts in downstream markets. 4. A change in price or quantity in any market translates into demand shifts in upstream markets. Participants Markets Product (m=many,f=few,1=one) Type of Market SHIFTS OF: Differentiation SELLERS BUYERS (eg. Monopoly, SUPPLY DEMAND I=international,N=national, (Y= yes, N=no) competition,etc) Left Right Left Right R=regional, L=local Lawyers Seller Law firms Labor market Buyer Extent: I N R L Seller Lawyer Doctors Buyer Services Extent: I N R L Seller Doctor Medical Schools Buyer Services f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Write down one market Type Circle One of the four possibilities Extent: I N R L Seller Med Students Y Nm Education Services Buyer Extent: I N R L Circle one for each market Circle One Circle One Circle One Participants Computer Graphics Experts Computer Graphics Firms Product (m=many,f=few,1=one) Type of Market SHIFTS OF: Differentiation SELLERS BUYERS (eg. Monopoly, SUPPLY DEMAND competition,etc) Left Right Left Right I=international,N=national, (Y= yes, N=no) R=regional, L=local Monopolistic Seller Labor Market Markets Buyer Seller Extent: I N R L computer Graphics Y Nm Ad agency Buyer Seller Brewers Distributors American Style Bars Buyer Seller Buyer Seller f 1 m f 1 f 1 m f 1 Y Nm f 1 m f 1 Y Nm f 1 m f 1 Brewing Extent: I N R L Y Nm f 1 m f 1 Retail food & Drink Consumers Y Nm Buyer ___________ Monopolistic Competition ___________ Monopolistic Competition Oligopoly? ___________ Monopolistic Competition Wholesale Beer Extent: I N R L Competition ___________ Monopolistic Competition Extent: I N R Advertising Svcs. L Buyer Seller Y Nm f 1 m f 1 ___________ Monopolistic Competition X A B CD X A B CD X A B CD X A B CD X A B CD ___________ O A B CD Write down one market Type Circle One of the four possibilities Extent: I N R L Circle one for each market Extent: I N R L Circle One Circle One Circle One Participants Markets Product (m=many,f=few,1=one) Type of Market SHIFTS OF: Differentiation SELLERS BUYERS (eg. Monopoly, SUPPLY DEMAND I=international,N=national, (Y= yes, N=no) competition,etc) Left Right Left Right R=regional, L=local Seller Buyer Extent: I N R L Y Nm f 1 m f 1 ___________ A B C D Extent: I N R L Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Y Nm f 1 m f 1 ___________ A B C D Write down one market Type Circle One of the four possibilities Seller Buyer Seller Buyer Extent: I N R L Seller Buyer Extent: I N R L Circle one for each market Circle One Circle One Circle One Rein in Runaway Costs Associated With Malpractice Insurance By Daniel H. Belsky, DO, MSc, Boca Raton, Florida in JAOA Vol 103 #6 (June, 2003) p. 263 Letters 1. I may just be a country doctor from the Pine Barrens of New Jersey, but I have learned some basic math Through the years. Although there has only been a tenfold increase in the cost of many staple items in the United States, the cost of medical malpractice insurance has multiplied a thousandfold. Am I missing information that would help explain why malpractice insurance rates are completely out of line with the rest of our economy?… 2. How many in the medical profession have been called to the emergency departments of our hospitals to tend to an Automobile accident victim, a woman with an incomplete abortion, or a woman having a ruptured ectopic pregnancy? How many in the medical profession have refused to render care to those patients because of their inability to pay? How many in the medical profession have conducted clinics for the needy in our communities without renumeration (sic.) or have waived fees for patients in our offices when they had fallen on hard times? If attorneys offered their pro bono and contingency fee programs to alleged victims of malpractice who cannot afford services and, on successful Settlement, then collected a fee for hourly services and expenses, that would be a fair and equitable system and Would ultimately result in lower malpractice insurance rates. I would call that pro bono plus. 3. Another way to bring down the number of expensive medical malpractice lawsuits involves a time-honored system to deal with injury in the workplace. It is called compulsory arbitration. The injured employee has his or her case reviewed by an arbitration board, usually consisting of a union representative, a physician who is an expert in the area of practice, an attorney, and a lay member. Responsibility is assigned, contributory negligence is determined, and the board recommends a dollar amount as award. The employee has the option of accepting the decision or taking the issue further with a lawsuit. If the case makes it to trial, the jury may be informed that the plaintiff turned down an award recommended by the arbitrators…. 4. There is a move afoot at both the state and federal levels to put a cap on awards for noneconomic damage (ie., pain and suffering). Arguments abound on both sides of the issue, but I have no doubt that limiting awards to reasonable amounts would help to drive down the cost of malpractice insurance. Once again, however, we face the obstacle of attorney-dominated legislatures. 5. Attorneys have another gimmick to unnerve and harass the medical profession and generate even larger legal fees: punitive damages. A physician being sued has to seek private counsel to defend against punitive damage, as that aspect is not covered in a malpractice policy. The threat of the question of liability may force many physicians to rush to settlement. This aspect of the law should be handled the same as for noneconomic damages discussed earlier to rein in the runaway costs of malpractice insurance. Cont’d 6….It has been estimated that approximately 6% of physicians account for 100% of medical malpractice cases. If this is true, we, as a profession, had better police ourselves more effectively and act quickly when indicated. There are several ways to deal with chronic offenders. A supervisor could be assigned to oversee patient care provided by a physician with a history of malpractice lawsuits. A similar program could be instituted in a private practice. Finally, physician retraining Programs could be initiated by hospitals and medical schools. The physician in question should be held responsible for all costs associated with his or her rehabilitation program. The state boards of medical examiners have to become more involved in the process, suspending or revoking the licenses of chronic offenders who defy rehabilitation. 7…Will true reform ever take place in the arena of medical malpractice? I think that it had better- and soon. Our brightest people are being forced to leave specialty areas with particularly high malpractice insurance rates, leaving academic Environments for more rural areas of the country with lower medical malpractice insurance rates. What a sad loss for our academic institutions. Will young scientific minds continue to be attracted to the medical profession? I fear that most will find other ways to pursue careers in the sciences. Although the cost of malpractice insurance continues to rise and the fixed costs of running an office are also increasing, the revenues in physicians’ practices continue to decline in an inverse ratio as the result of decreased managed care reimbursements. Organize the following actors into a vertical chain Patients Lawyer Services Lawyers Labor Market (Lawyers) Doctors Labor Market (Doctors today) Law Firms Labor Market (Doctors in the Educational Services future) Med Schools Medical Students Participants Markets Lawyers Law firms Seller Labor market(Lawyers) Buyer Seller Lawyer Services Doctors Buyer Seller Labor Market (Drs. today) Medical SchoolsBuyer Seller Med Students Buyer Seller Patients Buyer Education Services Labor Market (Doctors in the future) Participants Markets Lawyers Law firms Seller Product (m=many,f=few,1=one) Type of Market SHIFTS OF: Differentiation SELLERS BUYERS (eg. Monopoly, SUPPLY DEMAND (Y= yes, N=no) competition,etc) Left Right Left Right Labor market(Lawyers) Y M f 1 m F 1 ___________ A B C X Buyer Seller Lawyer Services Doctors Y m F 1 M f 1 ___________ A B C D Buyer Seller Medical SchoolsBuyer Seller Med Students Buyer Seller Patients Buyer Labor Market (Drs. today) Y M f 1 mF 1 Education Services Y Labor Market (Doctors in the future)Y ___________ A B C D mF 1 M f 1 ___________ X B C D M M f 1 ___________ X B C D f 1 Participants Markets Writers Book Publishers Product (m=many,f=few,1=one) Type of Market SHIFTS OF: Differentiation SELLERS BUYERS (eg. Monopoly, SUPPLY DEMAND I=international,N=national, (Y= yes, N=no) competition,etc) Left Right Left Right R=regional, L=local Seller Unpublished Manuscripts Buyer Extent: I N R L Seller Book DistributorsBuyer Seller Amazon Customers Buyer Y Nm f 1 m f 1 Book mfg. Y Nm Extent: I N R L Wholesale Books Y Nm Retail Mkt. Buyer Extent: I N R L Circle one for each market Y Nm X A B C D ? X A B C D ___________ f 1 m f 1 ___________ f 1 m f 1 Oligopoly ___________ A B C D f 1 m f 1 Oligopoly ___________ A X B C D Extent: I N R L Seller ? Circle One Circle One Circle One Write down one market Type Circle One of the four possibilities Participants Markets Hospital Orderlies Product (m=many,f=few,1=one) Type of Market SHIFTS OF: Differentiation SELLERS BUYERS (eg. Monopoly, SUPPLY DEMAND I=international,N=national, (Y= yes, N=no) competition,etc) Left Right Left Right R=regional, L=local Seller Labor Market Buyer Extent: I N R L Hospital Supply Seller Biotech Cos. Buyer Y Nm Outdated donated blood Extent: I N R L Y Artificial blood Y Surgery & Trauma units Buyer Extent: I & N Trauma R L Surgery Seller Services Y Consumers Buyer Seller f 1 m f 1 ___________ A B C D Nm f 1 m f 1 Nm f 1 m f 1 Bilateral ___________ A B C D Oligopoly “ ___________ X A B C D Nm f 1 m f 1 ___________ X A B C D Extent: I N R L Circle one for each market Circle One Circle One Circle One Write down one market Type Circle One of the four possibilities