Hospitals, Market Share, and Consolidation

被引:246
作者
Cutler, David M. [1 ]
Morton, Fiona Scott [2 ]
机构
[1] Harvard Univ, Dept Econ, Cambridge, MA 02138 USA
[2] Yale Univ, Sch Management, New Haven, CT USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2013年 / 310卷 / 18期
基金
美国国家卫生研究院;
关键词
MORTALITY; VOLUME; COSTS;
D O I
10.1001/jama.2013.281675
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A large reduction in use of inpatient care combined with the incentives in the Affordable Care Act is leading to significant consolidation in the hospital industry. What was once a set of independent hospitals having arms-length relationships with physicians and clinicians who provide ambulatory care is becoming a small number of locally integrated health systems, generally built around large, prestigious academic medical centers. The typical region in the United States has 3 to 5 consolidated health systems, spanning a wide range of care settings, and a smaller fringe of health care centers outside those systems. Consolidated health systems have advantages and drawbacks. The advantages include the ability to coordinate care across different practitioners and sites of care. Offsetting this is the potential for higher prices resulting from greater market power. Market power increases because it is difficult for insurers to bargain successfully with one of only a few health systems. Antitrust authorities are examining these consolidated systems as they form, but broad conclusions are difficult to draw because typically the creation of a system will generate both benefit and harm and each set of facts will be different. Moreover, the remedies traditionally used (eg, blocking the transaction or requiring that the parties divest assets) by antitrust authorities in cases of net harm are limited. For this reason, local governments may want to introduce new policies that help ensure consumers gain protection in the event of consolidation, such as insurance products that charge consumers more for high-priced clinicians and health care centers, bundling payments to clinicians and health care organizations to eliminate the incentives of big institutions to simply provide more care, and establishing area-specific price or spending targets.
引用
收藏
页码:1964 / 1970
页数:7
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